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•H 



A 
'♦ 



Special attention is called to the following: 

The next Annual Meeting of the MEDICAL SOCIETY 
OF New Jersey will be held at Asbury Park, on the 
23d, 24th and 25th of June, 1903. 

Each District Society is entitled 'to three Delegates at 
large and one additional delegate for every ten members. 

Permanent Delegates are to be elected this year (1903) 
and all District Societies are entitled to select nominees 
in accordance with the requirements of the by-laws and 
the amendments thereto. (See Trans., 1899, page 73.) 

The District Reporters are requested to send their 
reports to the Chairman of the Standing Committee 
at least two weeks before the time of the Annual 
Meeting. 

The Standing Committee would remind Reporters 
that their reports are published in the volume of 
Transactions, and should therefore be carefully prepared, 
and that names and. medical terms, especially, should be 
distinctly written. Reports from other physicians 
should be incorporated in their own report. 

The Secretaries of the District Societies are 
requested to send with their list of the Ofificers, Annual 
Delegates and Active Members in regular standing, a 
separate list of the Delinquent Members, regular practi- 
tioners not members of any County Society, homeo- 
pathic, eclectic, and all irregular practitioners of medicine, 
with the post-office addresses, to the Recording Secre- 
tary, Dr. Wm. J. Chandler, South Orange, at least thirty 
days before the Annual Meeting, in order that the pro- 
grammes may be sent out earlier, and to every member 
of the District Societies. 

The assessment upon the District Societies for the 
year ending June, 1903, is $1.00 for each member. 



FELLOWS' PRIZE ESSAY. 



This Prize was instituted by the Fellows of the Medical 
Society of New Jersey in 1881 ; several awards have since 
been made and it is open for competition this year to the 
members of the District Medical Societies. 

The Fellows have chosen as the subject for this year's 
Essays, ** Vaccination " and require that the following 
points shall be specially considered : Its protective power 
and the reason thereof ; the technique of the operation ; 
the abnormalties of, and the pathological conditions inci- 
dent to vaccination ; the neccessity for its repetition 
and the frequency with which it should be repeated. 

The Essays should not contain less than 2000 nor more 
than 3000 words and must be characterized by originality 
in thought and by clearness and conciseness of expression, 
and be, in the judgment of the Committee, of decided 
value to the members of the Society and the profession 
generally. Failing in these respects, no awards will be 
made. 

They must be signed with an assumed name and have 
a motto both of which shall be endorsed on a sealed 
envelope containing author's name and District Society. 

The Essays with the sealed envelope must be placed 
in the hands of the Chairman of the Committee on or 
before the first day of May, 1903. The Committee will 
select the first two Essays in order of merit. To the 
first will be awarded the prize of one hundred dollars ; 
to the second, that of honorary mention. 

The unsuccessful authors will receive back their Essays 
upon their identification to the Chairman of the Commit- 
tee. The successful Essays will be the property of the 
Society and be published in its Transactions. 

JOHN D. McGILL. M. D.. Chairman, Jersey City, 
DAVID C. ENGLISH. M. D.. New Brunswick. 
THOMAS J. SMITH. M. D.. Bridgeton, 

Committee, 

Jersey City, N. J., August i, 1902. 



TRANSACTIONS 



OF THE 



Medical Society 



OF 



NEW JERSEY. 



1902. 



L. J. Hardham, Printer, 243 6^ 245 Market Street, Newark, N. J. 

1902. 



OFFICERS, 1902 



E. L. B. GOD 




Camden 



7 DENTS. 



HENRY MITCHELL, . 
A. W. TAYLOR, 
WALTER B. JOHNSOxN, 



AsBURY Park 

Beverly 

Paterson 



CORRESPONDING SECRETARY. 

E. W. HEDGES, . . . \ Plainfield 



WILLIAM J. C 




South Orange 



ARCHIBALD MERCER, 

STANDING COMMITTEE. 

TERM EXPIRES I905. 

HENRY W. ELMER, Chairman, 

B. A. WADDINGTON, .... 



Newark 



Bridgeton 
Salem 



TERM EXPIRES I903. 

G. H. BALLERAY, . . . . 
W. H. IRELAND, 



Paterson 
. Camden 



TERM EXPIRES I904. 



CHARLES YOUNG, 
JOHN P. HECHT, 



Newark 
Somerville 




FELLOWS. 



All persons who shall have been, or may hereafter be President of the Society, shall rank as 

Fellows, and be entitled to all the privileges of delegated members. 

Act of Incorporation^ Sec. i. 
The dates represent the year of election as President. 

Those marked thus (♦) are deceased. 



♦Robert McKean 1 766 

♦William Burnett 1767 

♦John Cochran 1768 

♦Nathaniel Scudder 1770 

♦Isaac Smith ...1771 

♦James Newell 1772 

♦Absalom Bainbridge 1773 

♦Thomas Wiggins 1774 

♦Hezekiah Stites 1775 

***** 

♦John Beatty 1782 

♦Thomas. Barber 1 783 

♦Lawrence Van DERVEER.1784 

♦Moses Bloomfield 1785 

♦William Burnett 1786 

♦Jonathan Elmer 1787 

♦James Stratton 1 788 



♦Charles Smith 

♦Matt. H. Williamson. 

♦Samuel Forman 

♦John Van Cleve 

♦Lewis Dunham 

♦Peter I. Stryker 

♦John Van Cleve 

♦Lewis Condict 

*James Lee 

♦William G. Reynolds. 
♦Augustus R. Taylor.. 

♦William B. Ewing 

♦Peter L Stryker 

♦Gilbert S. Woodhull. 
♦Wm. D. McKissack . . . . 

♦Isaac Pierson 

♦Jeptha B. Munn 

♦John W. Craig 



♦Moses Scott 1789 

♦John Griffith 1790 ♦Augustus R.Taylor. 

♦Lewis Dunham 1791 ♦Thomas Yarrow 

♦Isaac Harris 1792 

♦Elisha Newell 1795 

♦Jonathan F. Morris 1807 

♦Peter I. Stryker 1808 

♦Lewis Morgan 1809 

♦Lewis Condict 1810 



♦FiTZ Randolph Smith. 

♦William Forman 

♦Samuel Hayes 

♦Abm. p. Hageman 

*Henry Van Derveer.. 
♦Lyndon A. Smith 



811 
812 
814 
815 
816 

817 
818 
819 
820 
821 
822 
823 
824 
825 
826 
827 
828 
829 
830 

831 
832 

833 

834 

835 
836 

837 



MEDICAL SOCIETY OF NEW JERSEY. 



♦Benj. H. Stratton 

♦Jabez G. Goble 

♦Thomas P. Stewart 

♦Ferdinand S. Schenck.. 

♦Zachariah Read.. 

♦Abraham Skillman 

♦George R. Chetwood. . . 

♦Robert S. Smith 

♦Charles Hannah 

♦Jacob T. B. Skillman 

♦Samuel H. Pennington. 

♦Joseph Fithi an 

♦Elias J. Marsh 

♦John H. Phillips 

♦Othn'l H. Taylor 

♦Samuel Lilly 

♦A. B. Dayton 

♦J. B. Coleman 

♦Richard M. Cooper 

♦Thomas Ryerson 

♦Isaac P. Coleman 

♦John R. Sickler 

♦ Wm. Elmer. 

♦JNO. Blane 

♦jno. woolverton 

♦Theo. R. Varick 

♦Ezra M. Hunt 

♦Abram Coles 

♦Benjamin R. Bateman.. . 

jNO. C. Johnson 

♦Thomas J. Corson 

♦William Pierson 



838 ♦Thomas F. Cullen 1 870 

839 ♦Charles Hasbrouck 1871 

840 *Franklin Gauntt 1872 

841 ♦T. J. Thomason 1873 

842 ♦G. H. Larison 1874 

843 ♦Wm. O'Gorman 1875 

844 ♦jNO. V. SCHENCK 1 876 

845 ♦Henry R. Baldwin 1877 

846 ♦John S. Cook 1878 

847 Alex. W. Rogers 1879 

848 ♦Alex. N. Dougherty 1880 

849 ♦Lewis W. Oakley 1881 

850 ♦John W. Snowden 1882 

851 *Stephen Wickes 1883 

852 P. C. Barker 1884 

853 ♦Joseph Parrish 1885 

854 Charles J. Kipp 1886 

855 John W. Ward 1887 

856 H. Genet Taylor ; . 1888 

857 ♦B.A.Watson 1889 

858 *JAS. S.Green 1890 

859 Elias J. Marsh 1891 

860 George T. Welch 1 892 

861 John G. Ryerson 1893 

862 O. H. Sproul 1894 

863 William Elmer 1895 

864 T.J.Smith 1896 

865 David C. English 1897 

866 C. R. P. Fisher 1898 

867 Luther M. Halsey 1899 

868 *William Pierson 1900 

869 J. D. McGill 1901 



HONORARY MEMBERS. 



*David Hosack, New York 1827 

*J. W. Francis 1827 

♦John Condict, Orange 1830 

♦Usher Parsons, Rhode Island 1839 

♦Reuben D. Murphy, Cincinnati 1839 

♦Alban G. Smith, New York 1839 

♦Willard Parker, New York 1842 

♦Valentine Mott, New York 1 843 

♦Jonathan Knight, New Haven 1848 

♦Nathaniel Chapman, Philadelphia 1848 

♦Alexander H. Stephens, New York 1848 

♦John C. Warren, Boston 1 849 

♦Lewis C. Beck, New York 1850 

♦John C. Torre y. New York 1 850 

♦George B. Wood, Philadelphia 1853 

♦H. A. Buttolph, Short Hills, N. J 1854 

♦Ashbel Woodward, Franklin, Conn 1861 

♦Thomas W. Blatchford, Troy, N. Y 1861 

♦Jeremiah S. English, Manalapan, N. J 1867 

♦Stephen Wickes, Orange, N. J 1868 

♦S. O. Vanderpool, Albany, N. Y '. 1872 

♦Joseph Parrish, Burlingtpn, N. J 1872 

♦Ferris Jacobs, Delhi, N. Y 1872 

C. A. LiNDSLEY, New Haven, Conn 1872 

♦\Vm. Pepper, Philadelphia 1 874 

S. WiER Mitchell, Philadelphia 1876 

Cyrus F. Brackett, Princeton, N. J 1880 

♦Joseph C. Hutchinson, Brooklyn, N. Y 1880 

Thomas Addis Emmett, New York 1884 

♦Isaac E. Taylor, New York 1884 

♦D. Hayes Agnew, Philadelphia 1886 

^Jos. Leidy, Philadelphia 1886 

Frederick S. Dennis, New York 1893 

♦John H. Ripley, New York 1893 

Virgil P. Gibney, New York .1893 

♦William Pierson, Orange, N. J 1894 

Abram Jacobi, New York 1896 

Virgil M. D. Marcy, Cape May City 1896 

♦Samuel H. Pennington, Newark, N. J 1897 

Alfred A. Woodhull, Princeton, N. J 1901 

J. Leonard Corning, New York 1902 



PERMANENT DELEGATES. 

Atlantic— Theo. H. Boysen, Egg Harbor City 

B. C. Pennington, Atlantic City 

W. B. Stewart, Atlantic City 

Bergen— Henry C. Neer, Park Ridge 

Daniel A. Currie, Englewood 

David St. John, Hackensack 

Samuel E. Armstrong, Rutherford 

Burlington— J. Howard Pugh, Burlington . . 

N. Newlin Stokes, Moorestown 

A. W. Taylor, Beverly 

Camden— Alexander Marcy, Riverton 

James M. Ridge, Camden 

Duncan W. Blake, Gloucester 

Onan B. Gross, Camden 

William H. Ireland, Camden 

'Daniel, Strock, Camden ... 

William H. Iszard, Camden 

William A. Davis, Camden 

Cumberland — S. T. Day, Port Norris 

M. K. Elme|1, Bridgeton 

T. J. Smith, Bridgeton 

O. H. Adams, Vineland 

Joseph Tomlinson, Bridgeton 

Essex— Arthur Ward, Newark 

Charles Young, Newark 

Joseph C. Young, Newark 

Herman C. Bleyle, Newark 

William J. Chandler, South Orange 

Edward J. Ill, Newark 

George R. Kent, Newark 

Daniel M. Skinner, Belleville 

Charles H. Bailey, Bloomfield 

Thomas S. Fitch, Orange 

Richard C. Newton, Montclair 

William Rankin, Newark 

Joshua W. Read, Newark 

George A. Van Wagenen, Newark 

James T. Wrightson, Newark 

Peter V. P. Hewlett, Newark . 

Theron Y. SuTPHEN, Newark 



896 

900 

900 

892 

899 

9C0 

901 

892 

895 

898 

892 

892 

895 

895 

895 

899 

899 

900 

899 

900 

900 

900 

902 

892 

892 

892 

896 

896 

896 

896 

896 

898 

898 

898 

89a 

898 

898 

898 

900 

900 



MEDICAL SOCIETY OF NEW JERSEY. 9 

Essex — Charles F. Underwood, Newark 1 9<5o 

L. Eugene HOLLiSTER, Newark 19^0 

Charles D. Bennett, Newark 19^0 

Henry B. Whitehorne, Verona 19^0 

William B. Graves, East Orange 1900 

Robert G. Stanwood, Newark 1900 

Thomas W. Harvey, Orange 1901 

Aaron K. Baldwin, Newark 1902 

Gloucester— George E. Reading, Woodbury 1893 

George C. Laws, Paulsboro 1895 

James Hunter, Jr., Wesiviile 1 898 

Hudson— J. D. McGill, Jersey City 1892 

Romeo F. Chabert, Hoboken 1892 

J. A. Exton, Arlington 1898 

Jos. M. Rector, Jersey City 19^0 

Frederick M. Corwin, Bayonne 1900 

Geo. E. McLaughlin, Jersey City 1900 

Mortimer Lampson, Jersey City 1900 

T. R. Chambers, Jersey City 19^0 

Hunterdon — Isaac S. Cramer, Flemington 1 892 

W. S. Creveling, Valley 1896 

George N. Best, Rosemont 1902 

Mercer— Cornelius Shepherd, Trenton 1892 

R. R. Rogers, Sr., Trenton 1895 

David Warm an, Trenton 1 897 

Elmer Barwis, Trenton 1898 

Thos. H. Mackenzie, Trenton 1900 

C. F. Adams, Trenton 1900 

J. C. Felty, Trenton 19°° 

Henry B. Costill, Trenton 1902 

Middlesex— Edward B. Dana, Metuchen 1 898 

Ambrose Treganowan, South Amboy 1898 

F. M. Donahue. New Brunswick 1900 

J. G. Wilson, Perth Amboy 1901 

Monmouth— Henry Mitchell, Asbury Park 1892 

D. McLean Forman, Freehold 1901 

Edwin Field, Red Bank 1901 

P. B. PUAIYEA, Allentown 1901 

George F. Wilbur, Asbury Park 1901 

F. C. Price, Imlaystown 1 901 

Samuel Johnson, Asbury Park 1901 

Cyrus Knecht, Matawan 1902 



lO MEDICAL SOCIETY OF NEW JERSEY. 

Morris— I. W. Condict, Dover 

Levi Farrow, Middle Valley 

Morris— CuTHBERT Wigg, Boonton 

James Douglass, Morristown 

Stephen Pierson, Morristown. 

F. W. Flagge. Rockaway 

Calvin Anderson, Madison 

Brixton D. Evans, Morris Plains 

Passaic— W. B. Johnson, Paterson 

P. A. Harris, Paterson 

George H. Balleray, Paterson 

John L. Leal, Paterson 

W. K. Newton, Paterson 

C. H. SCRIBNER, Paterson 

Robt. M. CURTS, Paterson.... 

James M. Stewart, Paterson 

John T. Gillson, Paterson 

Matthew A. Mackintosh, Paterson 

Andrew F. McBride, Paterson 

Salem— B. A. Waddington, Salem 

F. Bilderback, Salem 

W. H. James, Pennsville 

Henry Chavanne. Salem 

Somerset— S. O. B. Taylor, Millstone 

J. P. Hecht, Raritan 

A. L. Stillwell, Somerville 

Mary E. Gaston, Somerville 

Sussex— Sidney B. Straley, Andover 

E. Morrison, Newton 

B. W. Ferguson, Beemerville 

Union— Alonzo Pettit, Elizabeth 

E. B. Silvers, Rahway: 

J. Ackerman Coles, Scotch Plains 

T. H. Tomlinson, Plainfield 

James S. Green, Elizabeth 

N. L. Wilson, Elizabeth 

W. U. Selover, Rahway , 

Warren— William H. McGee, Belvidere 

Alva C. Van Syckle, Hackettstown 

J. M. Reese, Philipsburg 



892 
895 
899 
901 
901 
901 
901 
902 
892 
893 
896 
899 
899 
900 
900 
900 
900 
900 
902 
893 
899 
900 
900 
897 
898 
900 
902 
899 
899 

899 
893 

893 
896 

896 

900 

900 

9C0 

899 

899 

902 



Members of District Medical Societies 

REPRESENTED AT THE 

ANNUAL MEETING, 1902. 



. A b sec on 
Atlantic City 



ATLANTIC COUNTY. 

District Society organized June 7, 1880. Annual meeting firi>t week in February. 

Wm. E. Darnall, Pres., J. Addison Joy, Atlantic City 

Atlantic City E. H. Madden, 

Theo. Senseman, V.-Pres., Emery Marvel, 

Atlantic City Philip Marvel, 

Edward Guion, Sec. &* Treas., J. C. Marshall, 

140S Atlantic Ave., Atlantic City V. W. Metzler, 

A. B. Shimer, Rep., ** James North, 

W. A. Barnes, " B. C. Pennington, 

T. H. Boysen, Egg Harbor City W. M. Pollard, 



W. M. Powell, 
Eugene L. Reed, 
Thos. K. Reed, 



E. C. Chew, Atlantic City 

A. D. Cuskaden, " 

W. P. Conoway, " 

J. U. Elmer, Egg Harbor City Talbot Reed, 

W. B. Fayerman, Atlantic City Edward A. Reiley, 

Walter E. Reynolds, 

Pleasantville E. S. Sharpe, 

Atlantic City L. R. Souder, 

Bakersville J. W. Snowball, 

Atlantic City W. B. Stewart, 

M. L. Somers, 

Somers Point J. B. Thompson, " 

May 5 Landing J. Bart Webster, 
Atlantic City 

No. members, 42. 

BERGEN COUNTY. 

District Society reorganized February 28, 1854. Annual meeting second Tuesday in April. 



E. C. Filbert, 
C. M. Fish, 
C. Garrabrant, 
G. P. Gehring, 
J. J. Harward, 
E. H. Harvey, 
E. E. Howard, 
H. C. James, 
C. R. Johnson, 



Joseph Huger, Pres., Fort Lee Daniel A. Currie, Sec'y^Englewood 

J. E. Pratt, V.'Pres., David St. John, Treas., 

Schraalenburgh Hackensack 

J. W. Proctor, Rep., Englewood Sam'l E. Armstrong, Rutherford 



12 



MEDICAL SOCIETY OF NEW JERSEY. 



M. S. Ayres, 
H, M. Banks, 
Chas. D. Brooks, 
M. Blinckston, 
Chas. Calhoun, 



Fair view 

Englewood 

Hackensack 

Wesiwood 
Rutherford 



Howard McFadden, Hackensack 



E. E. Conover, Hasbrouck Heights 
Edgar K. Conrad, Hackensack 
J. F. Demund, Ridgewood 

H. C. Elsing, Ridgefield Park 
Geo. Bancroft Gale, Rutherford 
T. N. Gregory, Englezvood 

John J. Haring, Tenafly 

Fred. F. Hallett, Hackensack 

Eugene Jehl, 
J. B. W. Lansing, 

No. members^ 36. 



Park Ridge 

Closter 

Westwood 

Hackensack 

Englewood 

Westwood 

Hackensack 



Park Ridge 
Tenafly 



H. C. Neer, 

L. B. Parsell. 

B. D. Stone, 

A. A. Swayze, 

J. W. Terry. 

Theo. E. Townsend, 

A. L. Vandewater, 

Byron G. Van Home, Englewood 

William L. Vroom, Ridgewood 

Carrie H. Van Horn, Englewood 

J. T^lmage Wyckoff, Leonia 

F. H. White, Hackensack 

Max Wyler, Westwood 

Samuel J. Zabriskie, Fort Lee 



BURLINGTON COUNTY. 

Society organized May 19, 1829, Meets third Tuesday in January, April, June and 
October. Annual meeting third Tuesday in April. 

Irene D. Young, Pres., W. E. Hall, Burlington 

Bor dent own Jacob R. Haines, Mount Holly 



John B. Cassaday, V,-Pres., 

Burlington 
A. W. Taylor, Secy, Beverly 

E. HoUingshead, Treas., 

Pemberton 



Jacob C. Haines, Vincentown 

G. Eugene A. Harbet, Pemberton 
L W. HoUingshead, Philadelphia 
J. D. Janney, Cinnaminson 

Alex. Marcy, Riverton 



Joseph Stokes, Rep., Moorestown Wm. L. Martin, Rancocas 

R. H. ^Sivsons, Censor, Wm. P. Melcher, Mount ^olly 

Mount Holly Emma P. Weeks Metzer, 



W. C. Parry, Censor, Hainesport 
J. H. Pugh, Censor, Burlington 
W. H. Shipps, Hist,, Bordentown 



David Baird, Jr., 
J. E. Dubell, 
Florence A. Dyer, 
John J. Flynn, 
F. A. Gauntt, 



Florence 

Columbus 

Riverton 

Mount Holly 

Burlington 



T. T. Price, 
Elmer D. Prickett, 
A. H. Small, 
F. S. J. Stoddart, 
N. N. Stokes, 
F. G. Stroud, 



Riverside 

Tuckerton 

Mount Holly 

Riverside 

Reydal, Pa, 

Moorestown 



MEDICAL SOCIETY OF NEW JERSEY. 



13 



CONTRIBUTING MEMBER. 

William Martin, Bristol, Pa, 

HONORARY MEMBERS. 

Chas. p. Noble, i6jj Locust St., Chas. H. Thomas, ijop Locust St., 

Philadelphia, Pa. Philadelphia, Pa. 

E. P. Town send, Billings, Mont. 
No. members, 30. 

CAMDEN COUNTY. 

Organized August 14, 1846. Annual meeting second Tuesday in May. 



tt 



John G. Doran, Pres., 

207 N. 6th, Camden 

John W. Marcy, V.-Pres., 

Merchantville 

Paul M. Mecray, Sec'y 

405 Cooper, Camden 

Joel W. Fithian, Treas,, 

608 Broadway, " 

H. H. Sherk, Hist., 

2647 Westtield ave., " 

Joseph H. Wills, Rep., 

io« Cooper, " 

Joseph S. Baer, 

565 Stevens, " 
Wilson G. Bailey, 

Broadway and Pine, " 

Philip W. Beale. 

9th and Federal, 

Dowling Benjamin, 

215 Cooper, " 

John K. Bennett, 

Gloucester 

Duncan W. Blake, 
Charles S. Braddock, 

Haddonfield 

Walter S. Bray, 

2d and York. Camden 

Sylvan G. Bushey, 

7th and Pine, " 

Robert Casperson, 

215 N. 3d, " 

Alfred Cramer, 

433 Penn, 

William A. Davis, 

3d and Cooper, " 

Clarence B. Donges, 

525 Broadway, " 



John W. Donges. 

525 Broadway, Camden 

E. B. L. Godfrey, 

400 Linden, ^' 

Onan B. Gross, 

700 Market, " 

John J. Haley, 

Gloucester 

Levi B. Hirst, 

586 Federal, Camden 

Conrad G. Hoell, 

565 Benson, " 

Frank L. Horning, 

623 Market, 

Joseph E. Hurflf, 

Blackwood 

William H. Ireland, 

330 Cooper, Camden 

William H. Iszard, 

411 X. 4th, 

Harry' Jarrett. 

Broadway and Cherry, '' 

William B. Jennings, 

Haddonfield 

William S. Jones, 

20I Broadway, Camden 

William W. Kane. 

4th and Pine, 

William I. Kelchner, 

loth and Cooper, " 

Grant E. Kirk. 

1801 Broadway, " 

John F. Leavitt, 

52^ N. 3d, " 

Adrienette LeFevre, 

Blackwood 

Ahab H. Lippencott, 

108 Broadway, Camden 



14 



MEDICAL SOCIETY OF NEW JERSEY. 



Alexander McAllister. Emma M. Richardson, 

582 Federal, Camden 581 Stevens, Camden 

Alexander Marcy, Frank Neall Robinson, 

Riverton 518 Linden, " 

Frederick W. Marcy, Edward A. Y. Schellenger, 

332 Penn, Camden 429 Cooper, " 



J. W. Martendale, 

2303 Federal, 

Marcus K. Mines, 

713 s. 3d, 

Joseph L. Nicholson. 

4th and Penn, 

Milton VV. Osmun. 

815 Broadway, 

Howard F. Palm, 

614 N. 2d, 

William R. Powell. 

702 Market, 

William H. Pratt, 

406 N. 6th 

Sophia Presley, 

323 N. 4th, 

Ernest S. Ramsdell, 

423 Linden, 

James M. Ridge, 

302 Mickle, 



HaddonfieJ 

Blackwood 

Haddonfield 

Berlin 



Charles H. Shivers, 
J. Anson Smith, 
John R. Stevenson, 
Daniel Stout, 
Daniel Strock, 

818 Federal, Camden 

H. Genet Taylor. 

305 Cooper, " 

William A. Wescott, 

Berlin 

Wendell P. Wingender, 

6th and Penn, Camden 

E. B. Woolston, 

Marlton 



HONORARY MEMBERS. 

G. W. Boughman, J. W. Hewlings, 

Marshalltown, New Castle Co., Del. 

Richard C. Dean, J. G. Young, 

U. S. Navy 

Chas G. Garrison, J. Orlando White, 



No. members, 63. 



Merchantville 



CAPE MAY COUNTY. 



Moorestown 

Philadelphia Pa. 

Camden 



Society organized March 12, 1885. Meets first Tuesday in May and October. 

J. S. Douglas, Pres., Tuckahoe B. T. Abbott, Ocean City 

Jos. C. Marshall, V.-Pres., " Geo. B. Adams, WildwQpd 

N. A. Cohen, Secy, Wildwood C. B. Corson, Altoona, Pa. 

Randolph Marshall, Treas., John B. Dix, 

Tuckahoe Cape May Court House 

Walter S. Leaming, Censor, I. M. Downs, Court House 

Cape May City Chas. M. Gandy, U» S. Army 

Wm. A. Lake, Censor, Anna Hand, Cape May City 

Cold Spring A. L. Leach, " •* 

V. M. D. Marcey, Censor, James Mecray, •* 

Cape May City Emelin Physic, ** 



K 



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MEDICAL SOCIETY OF NEW JERSEY. 



15 



J. M. Slaughter, Wildwood Eugene Way, Dennisville 

Julius Way, Wesley R. Wales, Cape May City 

Cape May Court House 

HONORARY MEMBERS. 

Chas. M. Gandy, U, S. Army Jonathan Learning, 

Coleman Learning, Cape May Court House 

Cape May Court House J. H. Ingram, China 

No. members, 21. 

CUMBERLAND COUNTY. 

Society organized December 8, 1818. Annual meeting second Tuesday in April. 

H. G. Miller, Pres.^ Millville E. Stanley Goudy, Deerfield 

G. E. Day, V.-Pres., " L. L. Hand, 

J. C. Applegate, Sec'y, Bridgeton G. L. Harker, 

Jos. Tomlinson, Treas.^ " Jos. T. D. Howard, 

S. T. Day, Rep., Port Norris Lester Hummell. 

Vineland A. R. Judson, 

Cedarville Reba Lloyd, 

Millville Samuel D. Mayhew, 

Ocean City W. L. Newell, 

Bridgeton D. H. Oliver, 

Vineland W. F. Sawyer, 

Bridgeton T. J. Smith, 

'* S. M. Snyder, 

Vineland Ellsmore Stites, 

Bridgeton J. R. C. Thompson, 
J. W. Wade, 
C. W. Wilson, 

Millville S. M. Wilson, 
Cedarville 



O. H. Adams, 
F. M. Bateman, 
Samuel Bennett, 
N. H. Burt, . 
Alfred Corn well, 
C. B. Cunningham, 
T. G. Davis, 
E. L. Diament, 
Mary J. Dunlap, 
H. W. Elmer, 
M. K. Elmer, 
Edward S. Fogg, 
C. S. Franckle, 
Walter P. Glendon, 



Leesburg 

Port Norris 

Shiloh 

Greenwich 

New Port 

Bridgeton 

Millville 
Bridgeton 

Vineland 
Bridgeton 
Greenwich 
Bridgeton 
Bridgeton 

Millville 

Vineland 
Bridgeton 



ASSOCIATE MEMBERS. 

W. E. Ashton. Philadelphia, Pa. Chas. P. Noble, Philadelphia, Pa. 

J. M. Barton, 

J. Chalmers DaCosta, '• 

B. C. Hirst, 

W. W. Keen, 



It 



ti 



ti 



Chas. A. Oliver, 
David Reisman, 
H. A. Hare, 
Judson Daland, 

HONORARY MEMBERS. 

Ephraim Bateman, Cedarville Joseph Sheppard, 
No. members, 37. 



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ii 



41 



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Bridgeton 



i6 



MEDICAL SOCIETY OF NEW JERSEY. 



ESSEX COUNTY. 

Society organized June 8, x8i6. Annual meeting first Tuesday in April. 

Wellington Campbell, 



James T. Wrig^htson, Pres., 

12 Central avenue, Newark 

Walter S. Washington. V.-Pres., 

8 Washington place, Newark 

Archibald Mercer, Sec'y, 

31 Washington street, " 

Charles D. Bennett, Treas., 

167 Clinton avenue, " 

William S. Disbrow, Kep , 

151 Orchard street, " 

Maurice Asher, 

20 Court street, " 

Charles H. Bailey 

Bloomfield 

William O. Bailey, 

282 South Orange avenue, Newark 

Aaron K. Baldwin, 

291 Plane street, 

Samuel H. Baldwin. 

473 Clinton avenue, 

Winfred E. Baldwin, 

462 Orange street, 

Frederick W. Becker. 

478 Clinton avenue, 

Angelo R. Bianchi, 

103 Seventh avenue, 

Arthur W. Bingham, 

East Orange 

Herman C. Bleyle, 

118 Union street, Newark 

John H, Bradshaw, 

Orange 

Rudolph Braun. 

180 Polk street, Newark 

William M. Brien, 

Orange Valley 

James S. Brown, 

Montclair 

William Buerrman, 

352 Belmont avenue, Newark 

Charles V. Burke, 

136 Bowery street, " 

Edwin L. Burns. 

269 Broad street, " 

Robert L. Burrage, 

East Orange 

Carl Buttner, 

Orange 



Fletcher F. Carman, 



Short Hills 
Montclair 

William E. Carroll, 

481 Broad street, Newark 



Douglas A. Cater, 
William J. Chandler, 
Albion C. Christian, 



Orange 
South Orange 

Irvington 

J. Henry Clark. 

12 Walnut street, Newark 

Henry L. Coit. 

51 Halsey street, " 

Horace C. Cory, 

76 Central avenue, " 

Everit P. Cortright, 

24 Fulton street, " 

Theodore W. Corwin, 

5 West Park street, " 

Mathias S. Crane, 

41 Clay street, " 

David H. Crawford. 

14 Bridge street, " 

Maximillian Danzis. 

46 Mercer street " 

William H. K. Davis, 

Esat Orange 

John Dennis. 

287 Belleville avenue, Newark 

Winfield S. DeVausney, 

376 Broad street, '* 

Frank Devlin, 

90 Congress street, " 

Richard G. P Dieffenbach, 

222 South Orange avenue, 

Daniel xM. Dill, 

425 So. Orange avenue, " 

Waller Dodge, 

Orange 

Arthur C. Dougherty, 

158 Washington street, Newark 

John L. Duryee. 

436 High street, " 

Wells P. Eagleton, 

15 Lombard y street, " 



MEDICAL SOCIETY OF NEW JERSEY. 



17 



Sarah M. Edwards, 

207 Summer avenue, Newark 

Julius Egge. 

439 Washington street, " 

Linn Emerson, 

Orang-e 

David E. English, 

Millburn 

James R. English. 

800 Clinton avenue, Newark 

Joseph Fewsmith, 

47 Central avenue, " 

Thomas S. P. Fitch 

Orange 

Paul Fitzgerald. 

178 North Seventh street, Newark 

Richard P. Francis, 

Montclair 

Richard D. Freeman, 

South Orange 

Albert Frey, 

317 South Orange avenue, Newark 

Mathias T. Gaffney, 

211 Plane street, " 

Ruel S. Gage, 

17 Gould avenue, " 

Frank D. Garrison, 

South Orange 

William Gauch, 

199 High street, Newark 

Isabel M. Geddes. 

16 James street, " 

Robert F. Gillen, 

36 Clinton street, " 

Herman A. Glatzmayer, 

129 Wickliflfe street, " 

William M. Goodwin, 

88 Congress street, " 

Francis S. Gordon. 

271 Clifton avenue, " 

William B. Graves, 

East Orange 

Thomas N. Gray, 



kt 



Solomon Greenbaum, 

142 West Kinney street, Newark 

Chauncey B. Griffiths, 

145 Monmouth street, " 

Emil A. Guenthcr, 

159 West Kinney street, " 

John F. Hagar. 

88 Ferry street, " 



Charles W. Hagen. 

224 South Orange avenue, Newark 

John F. Hagerty, 

297 Central avenue, " 

Frederick W. Hagney, 

67 Pennsylvania avenue. " 

Eleanor Haines. 

934 Broad street, " 

Hugh M. Hart, 

16 Gouverneur street, " 

Levi W. Halsey, 

Montclair 

Edward H. Hamill, 

230 Koseville avenue, Newark 

Thomas N. Harvey, 

Orange 

E. Zeh Hawkes, 

15 Central avenue, Newark 

Joseph H. Haydon, 

448 High street, 

John Hemstath, 

36 spruce street. " 

Herman C. H. Herold, 

77 Congress street, " 

Peter V. P. Hewlett, 

181 Plane street, " 

William H. Hicks. 

425 South Orange avenue, '* 

Livingston S. Hinckley, 

182 Clinton avenue, *' 

James S. Hoffman, 

50 Waverly place, " 

Edgar Holden. 

13 Central avenue, " 

Edgar Holden, Jr., 

13 Central avenue, " 

L. Eugene Hollister, 

138 Clinton avenue, " 

George J. Holmes, 

1 1 07 Broad street, " . 

William J. Houck, 

110 Bloomfield avenue, " 

Ralph H. Hunt, 

East Orange 

Charles L. 111. 

188 Clinton avenue, Newark 

Edward J. 111. 

1002 Broad street, " 

Frederick C. Jacobson, 

108 Washington street ' 

Jotham C. Johnson, 

11 Tichenor street, " 



2 



i8 



MEDICAL SOCIETY OF NEW JERSEY. 



William A. Judson. 

270 Clifton avenue, Newark 

William F. Keim, 

7 Roseville avenue, " 

George R. Kent. 

37 Eighth avenue, " 

Charles J. Kipp, 

560 Broad street, " 

Joseph M. W. Kitchen. 

East Orange 

Francis E. Knowles, 

South Orange 

Henry A. Kornemann, 

249 Springfield avenue, Newark 

Stephen G. Lee, 

Orange 

Marie F. Lefort. 

300 Washington strict, Newark 

Charles F. Lehlbach, 

537 High street, " 

Jesse D. Lippincott, 

304 Summer avenue, " 

Frank W. Lockwood, 

East Orange 

Herbert W. Lon^. 

119 Madison street, Newark 

Thomas W. Loweree, 

30 Hill street, " 

Calista V. Luther, 

South Orange 

Ernest M. Lyon, 

2S2 Broad street. Newark 

Daniel L. McCormick, 

252 Mulberry street, " 

Henry D. McCormick, 

Verona 

Floy McEwan, 

56 Oriental street, Newark 

William H. McKenzie. 

942 Broad street, " 

Augusta M. Madison, 

188 Roseville avenue, " 

James M. Maghee, 

Orange 

William H. Martland. 

1 132 Broad street, Newark 

Henry E. Mathews, 

Orange 

Sarah R. Mead. 

16 James street, Newark 

Frank B. Meeker, 

61 First street, '* 



Pancrazio M. Me^aro. 

313 High street, Newark 

Elizabeth Mercelis, 

Montclair 

Franklin L. Meyer. 

122 Halscy street, Newark 

Andrew M. Mills. 

122 Washington street, " 

Augustus J. Mitchell, 

74 South street, " 

Winthrop D. Mitchell, 

East Orange 

Clement Morris. 

77 Washington avenue, Newark 

Eugene W. Murray, 

493 Summer avenue, " 

Frederick C. Nadler. 

33 Green street, '^ 

Albert B. Nash. 

10 South 13th street, " 

Emanuel Newman, 

81 New street, " 

Anna B. Newton, 

South Orange 

Richard C. Newton, 

Montclair 

Willis C. Noble, 

It 

Henry W. Nolte, 

255 Mulberry street, Newark 

Victor Parsonnet, 

134 West Kinney street, " 

Edward E. Peck, 

Caldwell 

William Pennington, 

Irvington 

Edward D. Phelan, 

56 Pennsylvania avenue, Newark 

Thomas F. Phelan,. 

Orange 

George P. Philhower, 

Nutle y 

Daniel W. Poor, 

East Orange 

Katherine Porter, 

Orange 

Robert C. Potter. 

34 Ccntrj street, Newark 

Henry A. Fulsford, 

South Orange 

John M. Rand, 

12 Hill strejt, Newark 



MEDICAL SOCIETY OF NEW JERSEY. 



19 



Charles H. Randall, 

50 3d avenue, Newark 

William Rankin, 

23 Cedar street, " 

Joshua W. Read, 

82 Park place, " 

Robert C. Ribbans, 

63 Central avenue, " 

Edward M. Richman. 

248 Mulberry street, " 

Philip Ricord, 

268 Bank street, " 

Samuel E. Robertson, 

344 Lafayette street, " 
Benjamin A. Robinson. 

265 Mulberry street, " 

Manning N. Robinson, 

159 Elm street, " 

William D. Robinson, 

* East Orange 

William J. Roeber, 

24 Monmouth street, Newark 

George A. Rogers. 

294 Bank street, " 

Robert H. Rogers, 

1195 Broad street, " 

Clarence Rostow. 

173 Spruce street, " 

George W. Rolerfort, 

243 Plane street, '* 

Mefford Runyon, 

South Orange 

Charles A. Schneider, 

172^2 Belmont avenue, Newark 

William A. Schopfer, 

43 Read street, " 

Charles A. Schureman, 

22 Hill street, " 

Emanuel Schwartz. 

561 High street, " 

Edward Sealy, 

369 Washington street, " 

Edgar C. Seibert, 

Orange 

William F. Seidler, 

21 Ferry street, Newark 

Marco Seidman. 

489 High street, " 

Sumner Schailer, 

1034 Broad street, " 

Elbert S. Sherman, 

159 Summer avenue '' 



William F. Shick, 

31 Park street, Newark 

M. Herbert Simmons, 

Grange 

Daniel M. Skinner, 

Belleville 

Anna L. Smith, 

Montclair 

E. Fayette Smith, 

y Fulton street, Newark 

D. Winans Smith, 

jor Walnut street, " 

Henry M. Smith, 

South Orange 

Joseph V. Somerhof, 

146 William street, Newark 

Edward Staehlin, 

493 High street, 

Jacob S. Stage, 

95 Jeflferson street, 

Robert G. Stanwood, 

117 North Sixth street, 

Edwin Steiner, 

492 High street, 

Carlyle E. Sutphen, 

185 Roseville avenue, 

Theron T. Sutphen, 

999 Broad street, 

Charles E. Teeter, 

418 Orange street, 

Francis J. E. T^treault, 

Orange 

♦Frederick W. Thum, 

149 Polk street, Newark 

Charles W. Titus, 

126 North Seventh street, " 

Henry A. Towle, 

16 Halsey street, " 

Sidney A. Twinch, 

598 Broad street, " 

Charles F. Underwood, 

259 Mt. Prospect avenue, " 

Herbert li. Vail, 

Belleville 

M. H. Cash Vail. 

Vailsburg 

Sarah E. Van Duyne, 

186 Belleville avenue, Newark 

George A. Van Wa^enen, 

loi North Sixth street, " 

Maria M. Vinton, 

Orange 



20 



MEDICAL SOCIETY OF NEW JERSEY. 



George N. Wait, 

569 High street, Newark 

David L. Wallace, 

202 Clinton avenue, " 

Henry J. F. Wallh?iuser, 

47 New street, '* 

Aaron C. Ward. 

325 Clinton avenue, " 

♦Arthur Ward, 

17 Lombardy street, " 

Edwin M. Ward. 

Bloomfield 

Leslie D. Ward, 

1058 Broad street, Newark 

George L. Warren, 

77 Houston street, " 

William H. Warren, 

443 Summer avenue, " 

Frederick Webner, 

96 Clinton avenue, " 

Louis Weiss, 

61 Beacon street, " 

George O. Welshman, 

150 Summer avenue, " 

Lars T. Wendelboe. 

104 West street, " 

No. members, 229.' 



Elmer G. Wherry, 

4x4 Clinton avenue, Newark 

Edward H. White, 

175 So. Orange avenue, Newark 

William H. White, 

Bloomfield 

Henry B. Whitchorne, 

Verona 

Miller R. Whitenack, 

19 Bathgate place, Newark 

Albert Wickman, 

325 Washington street, 

W. Stockton Wilson, 

96 Montclair avenue, 

Edward E. Worl, 

271 High street, 

James A. Wormley, 

83 New street, 

Charles Young, 

23 East Kinney street, 

Joseph C. Young, 

964 Broad street, 

Charles M. Zeh. 

481 Broad street. 



* Deceased. 



GLOUCESTER COUNTY. 

Society organized December, 1818. Annual meeting third Tuesday in January. 

Samuel F. Ashcraft, Pres.^ Charles M. Burk, Clarksboro 

Mullica Hill Henry C. Clark, Woodbury 

Joseph M. Husted, V,-Pres., Henry B. Diverty, *• 

Clayton Elias M. Duffield, Glassboro 

Geo. E. Reading, Sec*y &* Treas., J. Gaunt Edwards, Wtlliamstown 



Woodbury C. Frank Fisler, 

L. M. Halsey, Censor, T. Franklin Gifford, 

Williamstown Chas. S. Heritage, 

Jas. Hunter, Jr., Censor, Wesiville Eugene Z. Hillegas, 

Harry A. Stout, Censor, Wenohah George C. Laws, 

Wesley Grant Simmons, Rep,, M. Jones Luffbary, 

Swedesboro James C. McClurc, Wtlliamstown 

Wm. Brewer, Woodbury Eugene T. Oliphant, Bridgeport 

Ralph E. Buck, Ntwfield Cyrus B. Phillips, Hurfville 



Clayton 

Woodbury 

Glassboro 

Mantua 

Paulsboro 

Glassboro 



MEDICAL SOCIETY OF NEW JERSEY. 



21 



Albert Porch, Clayton William M. Stratton, Woodbury 

U. S. Grant Sparks, Mantua B. A, Waddington, Salem 

Samuel F. Stanger, Harrisonville Howard A. Wilson, Woodbury 
P. E. Stil wagon, Bridgeport 

HONORARY MEMBERS. 

George W. Bailey, Philadelphia William H. Iszard, Camden 



Hobart A. Hare, 
Judson Daland, 
E. E. DeGrofft. 
No. members. 30. 



(« 



Chas. P. Noble, 
Mordecai Price, 
Woodstown Chas. S. Turnbull, 



Philadelphia 



it 



«i 



(< 



HUDSON COUNTY. 

Society organized October i, 1851. Annual meeting first Tuesday in May. 



i( 



(i 



Oliver R. Blanchard, Pres., 

37 Clinton avenue, Jersey City 

Christopher D. Hill, Sec'y, 

102 Grand street, *' 

Henry H. Brinkcrhoflf. Treas,, 

695 Bergen avenue, Jersey City 

William F. Faison. Rep.^ 

105 Grand street, 

Ulamor Allen, 

235 Ogden avenue, 

H, D. Abbott. 

24 East 33d street, Bayonne 

Edward C. Armstrong, 

512 Fulton street, Town of Union 

Henry Allers. 

loq Harrison avenue, Harrison 

Edward P. lUiffett. 

804 Bergen avenue, Jersey City 

John J. Broderick, 

355 Pacific avenue, 

Edward L. I^ull, 

73 Madison avenue, 

Henry J. Bogardus. 

487 Bergen avenue, 

Nathan G. Bozeman. 

462 Jersey avenue, 

Frank F. Bowyer, 

262 Barrow street, 

John J. Bauman, 

66i Jersey avenue, 

E. Mills Baker, 

103 Wayne street, 

Louis Bauman. 

250 Fifth street. 



t( 



W. Sims Boyd, 

221 Eighth street, Jersey City 

Henry H. Burnett, 

724 Washington street, Hoboken 

J. G. Louis Borgmeyer, 

90 West Eighth street, Bayonne 

Burdette P. Craig, 
Boulevard & Highland ave., Jersey City 

John E. Corrigan, 

546 Bramhall avenue, *' 

Talbot R. Chambers. 
Mercer st. and Jersey ave., " 

Charles W. Cropper, 

85 Giflford avenue, " 

S. Herbert Culver, 

114 Magnolia avenue, '* 

Charles B. Converse, 

218 Palisade avenue, '* 

John A. Chard, 

14 Virginia avenue, *' 

D. Leroy Culver, 

287 York street, 

George M. Culver, 

549 Summit avenue, ^^ 

C. W. Crankshaw, 

2549 Boulevard, '' 

Romeo Chabert, 

104 Seventh street, Hoboken 

Frank M. Childs, 

927 Washington street, " 

Frederick W. Corwin, 

7 West Sixth street, Bayonne 

John F. Connelly, 

276 Avenue C, " 



22 



MEDICAL SOCIETY OF NEW JERSEY. 



Gordon K. Dickinson, 

278 Montgomery street, Jersey City 

Florence De Hart, 

99 Mercer street, "^ 

Edwin K. Dunkel. 

264 Montgomery street, " 

Arthur DeLon^, 

659 Jersey avenue, " 

Louis Dodson, 

662 Jersey avenue, " 

John W. Doherty, 

272 Barrow street, " 

R. H. Dinglestedt, 

6ig Hudson street, Hoboken 

Alexander Dallas, 

24 East 22d street, Bayonne 

Lucius F. Donohue, 

33 Dodge street, " 

M. O. F. Dolphin, 

112 Fourth street, Harrison 

Charles L. DeMerritt, 

302 Shippen street. West Hoboken 

Benjamin Edg^e, 

95 Wayne street, Jersey City 

Chauncey V. Everitt, 

38 Boyd avenue, " 

James G. Enwright, 

63 Wayne street, '' 

John R. Everitt, 

38 Boyd avenue, '' 

James A. Exton, 

75 Beach street, Arlington 

Joseph F. Finn, 

131 Danforth avenue, Jersey City 

John Faber. 

289 Central avenue, " 

N. Frederick Feury, 

687 Bergen avenue, '' 

William Friele, 

203 Palisade avenue, " 

Howard S. Forman, 

640 Bergen avenue, '' 

George D. Fyfe, 

76 Madison avenue, '' 

Charles H. Finke, 

315 York street, " 

Archibald C. Forman, 

41 West 32d street, Bayonne 

Leonard J. Gordon, 

Mercer street, Jersey City 

Frank D. Gray, 

568 Bergen avenue, " 



Lemuel G. Goode, 

898 Bergen avenue, Jersey City 

Charles A. Gilchrist, 

916 Hudson street, Hoboken 

R. W. Gelbach. 

809 Hudson street, " 

E. Gamson, 

41 West 24th street, Bayonne 

John P. Henry. 

907 Summit avenue, Jersey City 

Peter Hoffman. 

209 Pavonia avenue, " 

William L. Hetherington, 

299 Varick street, " 

Edward P. Hart, 

5!2S Jersey avenue, " 

Henry W. A. Haase. 

362 Communipaw avenue, " 

Samuel A. Heifer, 

626 Hudson street, Hoboken 

M. Hecht, 

324 Shippen street. West Hoboken 

J. Eugenia Jacques, 

74 Waverly street, Jersey City 
J. Morgan Jones. 

81 Sip avenue, " 

Calvin F. Kyte. 

316 Pavonia avenue, 

A. John Kirsten, 

289 Varick street, " 

Richard Kuehne. 

1118 Summit avenue, " 

G. A. Krauss, 

139 Mercer street, " 

William L. Kudlich. 

408 Hudson street, Hoboken 

Charles K. Law. 

Glenwood ave. & Boulevard, Jersey City 

Henry H. Lynch, 

591 Bramhall avenue, " 

Mortimer Lampson. 

322 Pacitic avenue, " 

Frederick E. Lambert. 

157 Ocean avenue, 

W. C. Lewis. 

339 Pacific avenue, " 

Charles A. Limeburner, 

79 Danforth avenue, " 

John T. Luck, 

Weehawken, Town of Union 

John D. McGill. 

124 Mercer street, Jersey City 



MEDICAL SOCIETY OF NEW JERSEY. 



23 



George E. McLaughlin, 

41 Crescent avenue, Jersey City 

John J. McLean. 

33 Hoboken avenue, " 

Frank W. Mallalieu. 

62 Monticello avenue, " 

Edward Mulvaney, 

487 Jersey avenue, " 

John J. Mooney, 

250 Third street, " 

G. W. Muttart, 

702 Ocean avenue, " 

Thomas C. McNamara, 

715 Park avenue, Hoboken 

Edward G. Marks, 

Elshernius st. & Kearny ave., Arlington 

John Nevin. 

138 Mercer street, Jersey City 

M. W. O'Gorman. 

38 Erie street, " 

A. W. Oestman, 

961 Summit avenue, " 

William J. Parker. 

fy)4 Herj^en avenue, " 

John C. Parsons. 

311 York street, " 

Charles H. Purdy, 

312 Montgomery street, " 

Imanuel Pyle. 

54 Monticello avenue, " 

Wallace Pvle, 

713 Bergen avenue, " 

H. S. PoUak, 

297 Varick street, " 

Luigi Pezzi, 

312 Third street, " 

Joseph M. Rector. 

307 York street, " 

Frederick C. Robertson. 

477 ocrgen avenue, " 

Gertrude Rochester, 

58 Patterson street, " 

Murray E. Ramsey, 

2 Park street, " 

U. L. Rowe, 

S70 Bergen avenue, " 

Henry B. Rue, 

931 Bl(K)mfield street, Hoboken 

James H. Rosenkranz, 

826 Hudson street, " 

Henry Spence, 

481 Jersey avenue, Jersey City 

No. members, 137. 



George W. Shera. 

489 Jersey avenue, Jersey City 

Robert Stewart, 

43a Madison avenue, ' 

Harry V. A. Smith, 

102 Palisade avenue, 

F. U. Sauer, 

552 Jersey avenue, ** 

E. T. Steadman. 

635 Washington street, Hoboken 

Walter Steadman, 

213 Garden street, " 

C. Irving Simon, 

722 Washington street, " 

George H..Sexsmith. 

719 Avenue C, Bayonnc 

Josiah L. Sanborn, 

17 East Thirty-third street, " 

Pliney F. Stevens, 

950 Avenue I>, 

August A. Strasser. 

IIS Beach street, Arlington 

Richard Schletnin, 

116 Palisade* avenue. Town of I'nion 

Frank D. Steilwagon, 

530 I'nifin place, '* 

L. H. Sheiner, 

Berganline avenue, " 

M. F. Squier, 

234 Harrison avenue, Harrison 

H. Melville Smith. 

72 Riggs place. South Orange 

Hamilton Vreeland, 

79 Summit avenue, Jersey City 

A. John Walscheid, 

3<x^ Fulton street. Town of I'nion 

J. W. Ware, 

Avenue C and 46th street, Bayonne 

William Perry Watson, 

.101 Bcntley avenue, Jersey City 

John E. West, 

636 Ocean avenue, " 

Otto A. Wiegand. 

1151 Summit avenue, " 

F. C. Wolff. 

1 1 36 Garden street, Hoboken 

Joseph Wolfson, 

302 Montgomery street, Jersey City 

Stanley R. Woodruff, 

22 West 22d street, Bay(jnne 



24 MEDICAL SOCIETY OF NEW JERSEY. 

HUNTERDON COUNTY. 

Society organized June la, 1821. Annual meeting fourth Tuesday in April. 

0. H. Sproul, Sec*y^ Flemington John H. Ewing, Flemington 
Isaac S. Cramer. Treas,, " Frank Grim, Bafiistpwn 
Geo. W. Bartow, Three Bridges Fred L. Johnson, Stanton 
Theo. W. Bebout, Moses D. Knight, Clinton 

Sterling, Morris Co, Frank W. Larison, Lambertville 

Willard E. Berkaw, Annandale Edward D. Leidy, Flemington 

Geo. N. Best, Rosemont Edward H. Moore, White House 

Wm. R. Carpenter, Little York Geo. L. Romine, Lambertville 

Wm. S. Creveling, Valley Leon T. Salmon, " 

Edward W. Closson, Lambertville Quintus E. Snyder, Quakertown 

HONORARY MEMBERS. 

H. p. Loomis, New York City W. D. Wolverton, 

U. S. Army, Retired 

No. members. 19. 

MERCER COUNTY. 

Society organized May 23, 1848. Annual meeting second Tuesday in May 

Alex. Armstrong, Pres., J. F. Chattin. 

36 Broad street, Trenton 40 West State street, Trenton 

George R. Moore. V.-Pres,, W. A. Clark, 

259 Hamilton avenue, " 51 West State street, " 

A. Dunbar Hutchinson. Secy, J. C. Craythorn. 

308 Centre street, '* Spring and Calhoun streets, " 

1. M. Shepherd, Treas., Paul L. Cort, 

188 South Broad street, " Box 258, " 

Martin W. Redden. Rep., Henry H. Costell, 

Perry street, " State and Clinton streets, " 

Charles F. Adams. Frank V. Cantwell, 

52 West State street, " Broad Street Bank Building, '' 

Charles L. Allen. A. H. Dey. 

Box 258, '* 430 East State street, " 

Elmer Barwis. P. J. Dorety, 

211 Hamilton avenue, " 235 North Warren street, " 

Henry M. Heatty. Wm. Elmer, 

Centre and Ferry streets, " 44 West State street, * ' 

Charles P. Britton. E. K. Fee, 

State and Warren streets, *' Lawrenceville 

A. T. Bruere. Geo. H. Franklin, 

106 Spring street, " Hightstown 

John Bruyere, J. C. Felty, 

123 Perry street, " Box 258, Trenton 

William M. Carlinjj. Samuel Freeman, 

230 South Clinton street, ' South Broad street, 



MEDICAL SOCIETY OF NEW JERSEY. 



25 



E. J. Gordon, 

loio South Clinton avenue, Trenton 

W. J. Hall. 

231 North Warren street, '' 

E. S. Hawkc. 

218 East Sute street, " 

A. I. Hunt, 

Hamilton square 

J. S. Jamison, 

43 West State street, Trenton 

Mozart Jenkins. 

136 Walnut avenue, " 

Wm. S. Lalor, 

129 North Warren street, Trenton 

Lyman Leavitt, 

212 Chestnut avenue, " 

Thos. H. MacKcnzie, 

528 East State street, *' 

Walter Madden, 

219 Centre street, " 

Benj. W. McGalliard, 

229 East State street, " 

James McGuire, 

South Broad street, " 

Chas. H. Mcllwaine, 

40 West State street, " 

Chas. Mitchell, 

Centre street, " 

H. G. Norton, 

429 East State street, ** 

N. B. Oliphant. 

IS2 West State street, " 

Geo. H. Parker, 

420 East State street, '''■ 

Elmer H. Rogers. 

126 North Warren street, " 



R. R. Rogers. Sr., 

I lo East Hanover street, Trenton 

R. R. Rogers, Jr., 

610 Perry street, " 

Geo. M. Ridgway. 

39 West State street, " 

Jos. B. Shaw, 

119 South Warren street, *' 

Cornelius Shepherd, 

186 South Broad street, " 

Geo. N. J. Sommer, 

229 Perry street, '* 

W. D. Stevenson. 

303 East State street, '* 

G. Schoening. 

223 Perry street, " 

Wm. McD. Struble, 

250 South Clinton street, " 

Geo. E. Titus, 

Higrhtstown 

Irvine Turner, 

Titusville 

W. B. Van Duyn, 

121 Perry street, Trenton 

Jno. W. Ward, 

Box 258, '' 

David Warman, 

Chestnut avenue, " 

David F. Weeks. 

400 West State street, " 

J H. Wikoff, 

Princeton 

Wm. Wilbur, 

Hightstown 

P. W. Yard. 

727 South Broad street, Trenton 



HONORARY MEMBER. 

Dr. Joseph K. Young, 

222 South Sixteenth street, Philadelphia. Pa. 

No. members, 62. 



MIDDLESEX COUNTY. 

Society organized Jnne z6, 1816. Annual meeting third Wednesday in April. 

Edward E. Haines, Pr^s., • David Stephens, S^cy, 

South Amboy New Brunswick 

Wm. E. Ramsey, V.-Pres., David C. English, Treas,, 

Perth Amboy New Brunswick 



26 



MEDICAL SOCIETY OF NEW JERSEY. 



Arthur L. Smith, Rep.^ 

New Brunswick 
J. C. Albright, South Aviboy 

Thomas Alslop, New Brunswick 
J. J. Bissett, Paterson 

H. M. Brace, Perth Am boy 

Edgar Carroll. Dayton 

S. V. D. Clark, New Brunswick 
A. Schuyler Clark, 
Edward B. Dana, Metuchen 

F. M. Donahue, New Brunswick 
Benj. Guttmann, New Brunsivick 



<( 



E. A. Meacham, South Amboy 

Wm. V. McKenzie, Metuchen 

D. L. Morrison, New Brunswick 

Wm. M. Moore, 

Ferdinand E. Riva, Milltown 

C. M. Slack, 

Ira T. Spencer, 

J. L. Suydam, 

.H. C. Symmes, 

A. Treganowan, 

G. \V. Tyrrell, 

J. Leon White, 



Woodbridge 

Jamesburg 

Cranberry 

South Amboy 

Penth Amboy 

Scuth Amboy 



A. C. Hunt, 
Henry Levy, 
John L. Lund, 

H. G. Cooke, 



Metuchen N. Williamson, New Brunswick 
** John G. Wilson, Perth Amboy 



HONORARY 
New Brunswick 



MEMBERS. 

J. C. Holmes, 



Cranberry 



No. members, 32. 



Atlantic Highlands 
A. H. Higgins, Manasquan 



G. C. Hoagland, 
W. H. Ingling, 
A. J. Jackson, 
Samuel Johnson, 
W. R. Kinmouth, 



MONMOUTH COUNTY. 

Society organized June i6, 1816. Annual meeting third Monday in May. 

Wm. M. Hepburn, /'r^^.. Freehold H. A. Hendrickson, 

D. McLean Forman, Secy, " 
L S. Long, Treas., '• 
Scudder f. Wooley, Rep., 

Long Branch 
A. T. Applegate, Englishtozvn 
Geo. H Baker, Lofig Branch 

E. M. Beach, West Long Branch 
R. S. Bennett, Asbury Park Cyrus Knecht, 
A. G. Brown, Red Bank S. R. Knight, 
Wm. W. Beveridge, Asbury Park W. U. Kurtz, 
Harvey Brown, F'reehold Sarah F. Mcintosh, Asbury Park 
Henry G. Cook, New Brunswick Wm. MacMillan, Perrineville 
Ellis W. Crater, Ocean Port Henry Mitchell, 
J. F. Davison, Asbury Park F. C. Price, 
V. M. Disbrow, Lakewood P. B. Pumyea, 
Edwin Field, Red Bank Edgar Roberts, 
D. D. Hendrickson, Middletown P. J. Rafferty, 



Keyport 

Adelphia 

Mat a wan 

Asbury Park 

Farmingdale 

Matawan 

Spring Lake 

Eatontown * 



Asbury Park 

Imlaystown 

A I ten town 

Keyport 

Red Bank 



MEDICAL SOCIETY OF NEW JERSEY. 



Harry E. Shaw, L^ong Branch W. W. Trout, 

W. G. Schaufler, Lakewood Wm. B. Warner, 

Edw. F. Taylor, Middletoivn Geo. F. Wilbur, 

John Taylor, Oceaji Grove Alex. Williamson, 

Charles H. Thompson, Btbnar W. S. Whiimore, 



Robert Laird, 
No. members, 44. 



HONORARY MEMBKRS. 
Manasquan George T. Welsh, 



Spring Lake 

Red Bank 

Asbury Park 



>( 



Oceanic 



Passaic 



MORRIS COUNTY. 

Society organized Juno i, 1815. Annual meeting second Tuesday in May. 



W. S. Foster, Pres., Flanders. 
J. Willard Farrow, V.-Pres., Dover 
H W. Kice, Secy, IVharlon 

Jas. Douglas, Treas., Morristown 
Stephen Pierson, Rep., 



N. H. Adsit, 
C. Anderson, 
R. D. Baker, 
G. A. Becker, 
C. G. Beling, 
L. F. Bishop, 
A. E Carpenter, 
A. R. Corwin, 

E. P. Cooper, 
H. H. Cossit, 

T. R. Crittenden, 

A. W. Condict, 
I. W. Condict, 
R. L. Cook, 

G. O. Cummins, 
Harris Day, 
H. V. Day, 
G. S. DeGroot, 

B. D. Evans, 
Levi Farrow, 

F. W. Flagge, 



Succasunna 

Madison 

Morris Plains 

Morristown 

Morris Plains 

Morristo^vn 

Boonton 

Morris Plains 

Troy Hills 

Morris Plains 

Dover 



<< 



(t 



i< 



Chester 

Bloomingdale 

Mend ham 

Morris Plains 

Hackettstown 

Rock aw ay 



G. H. Foster, 
Elliott Gorton, 
J. B. Griswold, 
H. A. Henriques, 
Geo. L. Johnson, 
A. A. Lewis, 
H. B McCarroll. 
A. A. Macwithey, 
P. S. Mallon, 
W. H. Martin. 
C. N. Miller. 
L. L. Mial, 
Clifford Mills, 
F. W. Owen, 
H. M. O'Riley. 
S. H. Reed, 
Wm. H. Risk, 
J. B. Risk, 
J. G. Ryerson, 
M. S. Simpson, 
E. Sutton, 
J. L. Taylor. 
H. C. Upchurch, 
Harry Vaughn, 



Rockawry 

Summit 

Morristown 



it 



Pomptou 
Morris Plains 

Madison 

German Valley 

Morristo7un 



Madison 
Summit 

Boonton 

Middle Valley 

German Valley 

Boonton 

Kenvil 

Morristown 



Geo. W. V. Wilkinson. 

J. Walters, Wharton 



28 



MEDICAL SOCIETY OF NEW JERSEY. 



Whippany W. J. Wolfe, 
Boonton 



H. S. Wheeler. 
Cuthbert Wigg, 

HONORARY MEMBERS. 

P. C. Barker, Morristown P. A. Harris, 

No. members, 55. 



Chatham 



Paterson 



PASSAIC COUNTY. 

Society organized July 14, 1844. Annual meeting third Tuesday in April. 



M. A. Mackintosh, Pres,, 

267 Ellison street, Paterson 

M. W. Gillson, V.-Pres., 

II Lee place, " 

J. G'Donnell. Secy. 

387 Main street, " 

George Fischer, Treas., 

Tj Fair street, " 
D. T. Bowden, Rep., 

117 Paterson street, " 

John L. Leal. Censor, 

29 Hamilton street, " 

Philander A. Harris, Censor, 

26 Church street, " 

H. Kip, Censor, 

90 Fair street, " 

F. E. Agnew, 

29 Hamilton street, " 

A. J. Alexander, 

379 Union avenue, " 

J. W. Atkinson, 

m North Main street, " 

George H. Balleray, 

1x5 Broadway, " 

J. H. Banta, 

119 Broadway, " 

J. V. Bergin, 

Bridge street, " 

Charles R. Blundell, 
W. Blundell, 

236 Main street, " 

J. A. Browne, 

310 Grand street, *' 

V. E. Bullen, 

156 Broadway, '' 

C. M. Campbell, 

642 Main street, " 

W. H. Carroll. 

1 1 Jefferson street, Passaic 



D. R. Crounse, 

84 Bloomfield avenue, Passaic 

R. M. Curts, 

30 Church street, Paterson 

G. S. Davenport, 

Garfield 

S. De Jager, 

94 Broadway, Paterson 
F. F. C. Demarest, 

29 Academy street, Passaic 

Edward F. Denner, 

26 Church street, Paterson 

T. J. Fitzmaurice, 

130 Beech street, " 

William Flitcroft, 

510 River street, " 

O. V. Garnett. 

154 Straight street, " 

J. T. Gilson, 

391 Main street, ' * 

J. H. Henggeler, 

Bridge street, " 

E. L. Henion, 

16 Church street, " 

W. B. Johnson, * 

170 Broadway, " 

C. J. Kane, 

349 Grand street, " 

T. J. Kane, 

349 Grand street, " 

F. J. Keller, 

349 Totowa avenue, " 

H. H. Lucas, 

192 Van Houten street, " 

Bryan C. Magennis, 

Bridge street, " 

E. J. Marsh, 

Park avenue, " 

W. W. McAlister, 

Little Falls 



MEDICAL SOCIETY OF NEW JERSEY. 



29 



A F. McBride, 

397 Main street, Paterson 

John C. McCoy, 

158 Broadway,. " 

J. R. Merrill, 

24 Church street, ' 

S. R. Merrill, 

17 Church street, " 

Daniel T. Millspaugh, 

Totowa avenue, " 

E. B. Morgan, 
C. F. W. Myers. 

108 Broadway, " 

R. Neer, 

85 Hamilton avenue, " 

W. Neer, 

87 Fair street, " 

W. K. Newton, 

379 Ellison street, '* 

T. F. G'Grady. 

374 Grand street, *' 

H. Parke. 

273 Main street, " 

T. L Paton, 

661 East Twenty-fourth ^treet, " 

J. P. Paxton, 
H. V. Pike, 

144 Hamilton avenue, '* 

AW. Rogers, 

285 Broadway, " 

B. H. Rogers, 

213 Broadway, " 

John N. Ryan, 

275 Passaic street, Passaic 

F. R. Sandt, 

354 Park avenue, Paterson 



C. H. Scribner, 

79 Ward street, Paterson 

W. R. Smith, 

' Little Falls 

J. W. Smith, 

33 Clark street, Paterson 

J. M. Stewart, 

Van Houten street, " 

R. Stinson, 

152 Broadway, " 

Isaac Surnamer. 

53 Bridge street, " 

M. J. Synott. 

Montclair 

J. Tattersall. 

1042 Main street, Paterson 

G. W. Terriberry, 

146 Broadway, " 

R. A. Terhune, 

Passaic 

P. H. Terhune, 

126 Park place, " 

F. H. Todd, 

120 Broadway, Paterson 

G. E. Tuers. 

190 Van Houten street, " 

A. B. Vanderbeck, 

160 Broadway, " 

A. Ward Van Riper, 

207 Main avenue, Passaic 

C. Van Riper, 

207 Main avenue, " 

George Vreeland, 

127 Hamburg avenue, Paterson 

F. Vigna, 

35 Ward street, " 



HONORARY MEMBER. 

J. C. Herrick, Colorado Springs^ CoL 
No. members, 77. 

SALEM COUNTY. 

Society organlzsd May 4, i83o. Annual meeting first Wednesday in May. 

B. A. Waddington, Pres,, Salem W. H. Carpenter, Rep,^ Salem 

H. T. Johnson, V.-Pres,, Dan*l Garrison, Censor^ 

Pedricktown Pennsgrove 

Henry Chavanne, Sec'y &» Treas.^ N. S. Hires, Censor, Salem 

Salem W. H. James, Censor, Pennsville 



30 



MEDICAL SOCIETY OF NEW lERSEY. 



F. liilderback, 
R. M. Davis, 
E. E. DeGroft, 
\V. L. Ewen, 

G. \V. H. Fitch. 



SaUm \V. T. Good, 
L. M. Halsey. 
IVoodstozu'n Geo. E.. Reading, 

Allow ay J. R. Richards, 
DarefozL-n 

ASSOCIATE MEMBER. 

\V. A. Jaquelt, D. D. S., SaAm. 



Qiiitilon 

\\ 'illiamstiywn 

Woodbury 

Fort Moti 



No. members, i6. 



SOMERSET COUNTY 



So iety organized May, i?i€. Anriual '.x^ttwuT, -is: l"r.i:rii.iy ia April. 



S. O. D. Taylor, Prgs., Millstone George Henr}*, 

A. L. Siillvvell, Secy^ Somerville W. H. Long, Jr., 

J. P. Hecht, Treas., " B. B. Matthews, 

J. H. Buchanan, Rep., J. F. McWilliam. 

North Plain field Josiah Meigh, 

J. E. Anderson, Neshanic \V. H. Merrell, 

J. B. Beekman, Pluckemin L. T. Reed, 

J. H. Cooper, Middlebush M. C. Smalley, 

H. V. Davis, North Branch F. C. Sutphen, 

A. H. Dundon, North Plainfield \V. J. Swinton, 



Ran' tan 

Somerville 

Bound Brook 

Somerville 

Bernardsville 

South Branch 

Somerville 

Gladstone 

Berna rdsville 

Somin.'ille 



C. R. P. Fisher, 
F. L., Field, 
T. H. Flynn, 
Mary E. Gaston, 



Bound Brook J. D. Ten Eyck, Franklin Park 
East Millstojie H. M. Weeks, Skillman Station 



Bound Brook 
North Plainfield 



Somerville F. A. Wild, 
P. J. Zeglio. 

HONORARY MEMBER. 

John VV. Ward, Trenton. 

ASSOCIATE MEMBER. 

E. R. Voorhees, M. D., C, Somerville, 
No. members, 27. 

SUSSEX COUNTY. 

Society organized August 22, 1829. Annual meeting third Tuesday in May. 



Jos. G. Coleman, Pres., Hamburg T. H. Andress, 

Milton N. Armstrong, V.-Pres., L. G. Burd, 

Newton Martin Cole, 

SKepard Voorhees, Sec'y, " C. K. Davison, 

E. Morrison, Treas., " C. E. Dovvling, 



Sparta 

Ogdensburg 

Hainesville 

Stanhope 

Sparta 



MEDICAL SOCIETY OF NEW JERSEY. 



31 



Chas. M. Dunning, 
B. W. Ferguson, 
Bruno Hood, 
M. D. Hughes, 
P. N. Jacobus, 
J. N. Miller, 



Carlos Allen, 
No. members, 21. 



Franklin Harvey J. McCloughan, Newton 

BeemerviUe John Moore, Sussex 

Newton J. B. Pellet, Hamburg 

Layton J. C. Price, Branchville 

Newton S. B. Straley, Newton 

*• H. D. Van Gaasbeck, Sussex 



HONORARY MEMBERS. 

Vernon Joseph Hedges, 



Branchville 



UNION COUNTY. 

Society organized June 7, 1869. Annual meeting second Wednesday in April. 



T. F. Livengood, Pres., 

1 105 East Jersey street, Elizabeth 

A. Stern, V-Pres., 

^18 East Jersey street, " 

J. P. Reilly. Secy, 

215 Elizabeth avenue, '* 

R. Mont fort, Treas., 

1051 East Jersey street, " 

P. DuBois Bunting. J^ep., 

II Third street, " 

F. C. Ard, 

Plainfield 
F. R. Bailey, 

1105 East Jersey street, Elizabeth 

T. F. Burnett, 

2^<) Court street, " 

William C. Boone, 



Plainfield 

Rah way 

Scotch Plains 

Berg^en Point 

Plain Held 



W. E. Cladek, 
J. Ackerman Coles, 
F; M. Corwin, 
John H. Carman, 
Marc L. Clowson, 
N. W. Currie, 



Alfred J. Donavan, 

■ 132 East Jersey street, Elizabeth 

Thomas F. Dolan, 

I2U Liviiij^ston street. 



James R. English, Jr., 

Irvinj^ton 

George \V. Endicott, 

Plainfield 

Joseph Funk, 

615 Elizabeth avenue, Elizabeth 

Edgar B. (jrier, 

1145 East Jersey street, Elizabeth 

James S. Green. 

463 North Broad street. " 

G. E. Galloway, 



William Gale, 
W. F. Gaston, 
H. I^age Hough, 
J. B. Harrison, 
B. W. Hoaghland, 
Ellis W. Hedges, 
B. Van O. Hedges, 
F. A. Kinch, 

W^ est field 

Horace R. Livengood, 

228 Elizabeth avenue, Elizabeth 

Monroe I). Long, 

Plainticld 

Victor ^lravl^J^^ 

I ) )j H^a.st Jersey street, IClizabclh 



Rah way 
We-,tfield 
Plainfield 

Rah way 

Wc-»t field 

WtKxlbridjfe 

Plainfield 



32 



MEDICAL SOCIETY OF NEW JERSEY. 



T. N. McLean, 

1 144 East Broad street, Elizabeth 

J. K. McConnell. 

Cranford 

William H. Murray, 

Plainfield 

E. R. O'Reilly, 

167 Second street, Elizabeth 

Alonzo Pettit, 

116 West Grand street, " 

Albert Peltis, 

Plainfield 

F. H, Pierson. 

440 North Broad street, Elizabeth 

Henry C. Pierson, 

Roselle 

N. H. Probasco, 

Plainfield 

J. B. Probasco, 
Stephen T. Quinn. 

125 Jefferson avenue, Elizabeth 

John M. Randolph, 

Rahway 

J. J. Reason, 

Carteret 

Charles H. Schlichter, 

1053 Elizabeth avenue, Elizabeth 

No. members, 62. 



Russell A. Shirrefs. 

1 1 58 East Jersey street, Elizabeth 

W. Updyke Selover, 



Rahway 



E. B. Silvers, 
Frederick W. Sell, 
R. R. Sinclair. 
G. W. Strickland, 



West field 
Roselle 



W. F. Turner, 

Z046 Elizabeth avenue, Elizabeth 

T. H. Tomlinson, 

Plainfield 

R. D. Tomlinson, 
N. W. Voorhees. 

297 North Broad street, Elizabeth 

A. F. Van Horn, 

Plainfield 

Norton L. Wilson, 

322 North Broad street, Elizabeth 

R. B. Whitehead. 

36 Third street, 

F. W. Wescott, 

Fanwood 



WARREN COUNTY. 



Society organized February 15, 1826. 

F. J. LaRiew, Pres , Asbury 

Chas. M. Williams, V,-Pres., 

Washington 
Wm. J. Burd, Sec'y, Belvidere 
Wm. H. McGee. Treas,, •• 
J. H. Griffith, Rep, Phillipsburg 
W. C. Albertson, 
Wm. C. Allen, 
Isaac Barber, 
C. H. Boyer, 
H. O. Carhart, 
No. members, 21. 



Annual meeting first Tuesday in June. 



Belvidere 

Blairstown 

Phillipsburg 

Riegelsville 

Blair stoTiVn 



Belvidere 

Stewartsville 

Vienna 

Oxford 

Blairstown 



G. W. Cummins, 
F. W. Curtis, 

F. W. Haggerty, 
L. B. Hoagland, 
John C. Johnson, 
L. C. Osmun, Washington, Z>. C. 
Louis C. Osmun, Hackettstown 
J. M. Reese, Phillipsburg 
C. B. Smith, Washington 

G. O. Tunison, Oxford 
Alva C.Van Syckle, Hackeitstow^^ 



SUMMARY. 



Atlantic, 


- 42 


Mercer, 


Bergen, 


36 


Middlesex, 


Burlington, 


- 30 


Monmouth, 


Camden. 


63 


Morris, 


Cape May, 


- 21 


Passaic, 


Cumberland, - 


37 


Salem, - 


Essex, 


- 229 


Somerset, 


Gloucester, 


30 


Sussex, 


Hudson, 


- 137 


Union, 


Hunterdon, 


19 


Warren, 



62 
32 

44 
55 

n 

16 

27 
21 

62 

21 



1061 



TRANSACTIONS 

OF THE 

Medical Society of New Jersey. 



Ond Hundred and Thirty-Sixth Annual Meeting. 



HELD IN ATLANTIC CITY, N. J.. 

JUNE 24, 25, 26, 1902. 

JOHN D. McGlLL, M.D., of Jersey City, President. 



FIRST DAY— TUESDAY. JUNE 24TH. 

The meeting was called to order by the President, Dr. 
John D. McGill, of Jersey City, in the New Rudolf Hotel, 
Atlantic City, at 11.20 A. M., there being about sixty 
members present. 

The report of the Committee on Credentials was pre- 
sented by the Secretary as follows : 

Owing to the continued misunderstanding as to the requirement 
that annual delegates should bring their certificates with them, many 
are present without their credentials and consequently not entitled to 
vote. However, enough regularly qualified delegates are present to 
enable the Society to open with a quorum. 

The following reporters from the following counties having fulfilled 
the requirements of the by-laws in sending in their reports ten days 
before the annual meeting, are ex-officio delegates and entitled to vote : 

Bergen^]. W. Proctor, Englewood. 

Burlington — Joseph Stokes, Moorestown. 

Camden — Joseph H. Wills, Camden. 

Essex — William S. Disbrow, Newark. 

Hudson — H. H. Burnette, Hoboken. 

Gloucester — W. G. Simmons. 

Hunterdon — 

Mercer — Martin W. Reddan, Trenton. 



36 MEDICAL SOCIETY OF NEW JERSEY. 

Middlesex — A. L. Smith, New Brunswick. 

Somerset — J. H. Buchanan. North Plainfield. 

Warren — J. H. Griffith. Phillipsburg. 

Nominees for permanent delegates are presented by the following 
counties : Cape May, Cumberland, Essex, Hunterdon, Mercer, Mon- 
mouth, Morris, Passaic and Warren. 

The following have presented certificates in proper form and are 
eligible for election: J. M. Reese, of Phillipsburg; B. D. Evans, of 
Morris Plains ; Henry B. Costill, of Trenton ; Joseph Tomlinson, of 
Bridgeton ; Cyrus Knecht, of Matawan. 

No credentials have as yet been received from Randolph Marshall, 
of Cape May ; \Vm. A. Lake, of Green Creek ; Aaron K. Baldwin, of 
Newark; Geo. N. Best, of Rosemont and Andrew F. McBride, of 
Paterson. Somerset County has not as yet presented the name of its 
nominee. 

On motion, the report was received. 

The following is a list of the delegates and members 
present during the session, as shown by the registration 
book : 

FELLOWS. 

Alex. W. Rogers, Paterson. O. H. Sproul, Flemington. 

Chas. J. Kipp, Newark. T. J. Smith, Bridgeton. 

John W. Ward, Trenton. David C. English, New Brunswick. 

H. Genet Taylor, Camden. C. R. P. Fisher. Bound Brook. 

Elias J. Marsh, Paterson. L. M. Halsey, Williamstown. 
John G. Ryerson, Boonton. 

OFFICERS. 
J. D. McGill. President. 
E. L. B. Godfrey, First Vice-President. 
Henry Mitchell, Second Vice-President. 
A. W. Taylor, Third Vice-President. 
E. W. Hedges, Corresponding Secretary. 
' Wm. J. Chandler, Recording Secretary. 
Archibald Mercer, Treasurer. 

STANDING COMMITTEE. 

Henry W. Elmer, Chairman. W. H. Ireland. 
B. A. Waddington. J. P. Hecht. 

G. H. Balleray. 



MINUTES. ' 37 

PERMANENT DELEGATES. 

Atlantic — Theo. H. Boysen, B. C. Pennington, W. B. Stewait. 

Bergen— Htnxy C. Neer, Daniel A. Currie. 

Burlington — J. Howard Pugh, A. W. Taylor. 

Camden — O. B. Gross, Wm. H. Ireland, D. W. Blake, Daniel 
Strock, Wm. H. Iszard, W. A. Davis. 

Cumberland — S. T. Day, M. R. Elmer, T. J. Smith, O. H. Adams. 

Essex — J. C. Young, W. J. Chandler, E. J. Ill, R. C. Newton, G. A. 
Van Wagenen, T. Y. Sutphen, J. T. Wrightson, C. F. Underwood, 
C. D. Bennett, R. G. Stanwood, A. K. Baldwin. 

Gloucester — G. E. Reading, James Hunter, Jr. 

Hudson — J. D. McGill, J. A. Exton, J. M. Rector, F. M.Corwin, 
G. E. McLaughlin, Mortimer Lampson, T. R. Chambers. 

Hunterdon — W. S. Creveling, Geo. N. Best, 

Mercer — Cornelius Shepherd, R. R. Rogers, Elmer Barwis, T. H. 
McKenzie, C. F. Adams, J. C. Felty, H. B. Costill. 

Middlesex — Ambrose Treganowan, F. M. Donahue. 

Monmouth — Henry Mitchell, P. B. Pumyea, Geo. F. Wilbur, 
F. C. Price. 

Morris — I. W. Condict, Cuthbert Wigg, Stephen Pierson. 

Passaic—^ . B. Johnson, P. A. Harris, J. L. Leal, G. H. Balleray, 
R. M. Curts, J. T. Gillson. 

Salem — B. A. Waddington, W. H. James, Henry Chavanne. 

Somerset — J. P. Hecht, Mary E. Gaston. 

Union — Alonzo Pettit, E. B. Silvers, J. S. Green, T. H. Tomlinson, 
N. L. Wilson, W. U. Selover. 
Warren — J. M. Reese. 

ANNUAL DELEGATES AND CORRESPONDING MEMBERS. 

Atlantic — A. A. Joy, C. R. Johnson, Philip Marvel, E. A. Reiley, 
W. M. Pollard, B. C. Pennington, H. C.James, Emery Marvel, W. E. 
Darnall, Theo. Senseman, Walter Reynolds, E. Guion, J. C. Marshall 
A. D. Cuskaden, J. W. Snowball, E. E. Sharpe, W. M. Barnes, W. B. 
Fayerman, B. R. Lee, A. B. Shiner, E. C. Chew, E. H. Harvey. 

Bur ling ton—K. H. Parsons, -E. Hollingshead, W. C. Parry, W. P. 
Melcher, F. G. Stroud, J. J. Flynn, W. E. Hall, G. E. Harbert, 
Wm. Martin, 

Camden — Paul M. Mecray, Emma M. Richardson, Alex. McAllister, 



38 MEDICAL SOCIETY OF NEW JERSEY. 

W. S. Jones, J. F. Leavitt, S. G. Bushey, Sarah Presley, J. W. 
Fithian, W. H. Pratt, D. Benjamin, A. H. Lippincott, C. G. Hocl, H. 
H. Sherk. 

Cape May — Randolph Marshall. 

Cumberland— ']QS>t^\i Tomlinson, W. L. Newell, Mary J. Dunlap, 
H. W. Elmer, T. G. Davis, W. P. Glcndon, G. E. Day, J. P. 
Applegate, N. H. Burt, D. A. Oliver. 

Essex— ^A, A. Palsford, H. D. McCormick, G. B. Philhower, E. E. 
Worl, W. P. Eagleton, E. E. Peck, P. M. Megaro, T. W. Corwin, 
Calista V. Luther, Sarah R. Mead, Isabel M. Geddes, H. L. Colt, 
W. E. Carroll. 

Gloucester — E. T. Oliphant, S. F. Stanger, J. G. McClure, J. G. 
Edwards, H. A. Wilson, S. F. Ashcraft, J. M. Husted, H. A. Stout, 
C. S. Heritage. 

Hudson — C. W. Crankshaw, J. H. Rosenkrans, A. A. Strasser, 
H. H. Brinkerhoff, C. H. Purdy, G. K. Dickinson, J. J. Broderick. 

Hunterdon — G. L. Romine, G. W. Bartow, E. W. Closson. 

Mercer— A\tx. Armstrong, Paul L. Cort, A. J. Hunt, A. D. Hutch- 
inson, W. L. Wilbur, G. H. Franklin, W. S. Lalor, M. W. Reddan, 
H. G. Norton, W. M. Struble. 

Middlesex — J. C. Albright, A. C. Hunt. 

Monmouth — W. R. Kinmouth, D. E. Roberts. 

Morris — A. A. Lewis, G. O. Cummins, J. L. Mial, E. Gorton, 
A. E. Carpenter. 

Passaic — H. H. Lucas, F. H. Todd, T. J. Fitzmaurice, A. J. 
Alexander, P. H. Terhune, W. R. Smith, D. T. Millspaugh. 

Salem — Daniel Garrison, E. E. DeGroft. 

Somerset — J. H. Buchanan. H. M. Weeks. 

Sussex — M. D. Hughes. 

Union — T. F. Livengood, Victor Mravlag, F. C. Ard, C. H. 
Schlichter, R. D. Tomlinson. 

Warren — C, B. Smith, G. O. Tunison. 

The following guests were present and were invited to 
sit with the Society as corresponding members: Frank 
A. Jones, Memphis, Tenn. ; Charles P. Noble, Phila- 
delphia; A. Bern Hirsh, Philadelphia; Joseph E. 
Girchnir, University of Maryland ; William M. Beach, 
Pittsburg, Pa. ; H. D. Beyea, Philadelphia; Mazyck P. 



MINUTES. 39 

Ravenel, University of Pennsylvania ; Mordicai Price, 
Philadelphia ; E. E. Montgomery, Philadelphia ; Dr. 

Rodneau, Philadelphia. 

The following Permanent Delegates were absent : 

Bergen — David St. John, Samuel £. Armstrong. 

Burlington^^, Newlin Stokes. 

^w^jr— Arthur Ward, Charles Young, H. C. Bleylc, Geo. R. Kent, 
D. M. Skinner, C. H. Bailey, T. S. Fitch.^Wm. Rankin, J. W. Read, 
P. V. P. Hewlett, L. E. Hollister, H. B. Whitehorne, W. B. Graves. 
T. W. Harvey. 

Gloucester — Geo. C. Laws. 

Hudson ^K. F. Chabert. 

Hunterdon — Isaac S. Cramer. 

J/.frr^r— David Warmar. 

Middlesex — E. B. Dana, J. G. Wilson. 

Monmouth — D. McL. Forman, Edwin Field, Samuel Johnson. 

Morris — Levi Farrow, James Douglass, F. E. Flagge, Calvin 
Anderson. 

Passaic^C H. Scribner, J. M. Stewart, M. A. Mackintosh. 

Somerset — S. O. B. Taylor, A. L. Stillwell. 

Sussex — E. Morrison, B. W. Ferguson. 

Union — J. A. Coles. 

Warren — Alva C. Van Syckle. 

The following Permanent Delegates have been absent 
from two consecutive meetings : 

Bergen — David St. John, Hackensack. 

Burlington — N. Newlin Stokes, Moorestown. 

Essex — L. E. Hollister, Newark. 

Passaic — M. A. Mackintosh, Paterson. 

Sussex — E. Morrison, Newton. 

Warren — Alva C. Van Syckle, Hackettstown. 

The reading of the minutes of the last annual meeting 
was commenced by the Secretary. It was moved and 
seconded that the further reading of the minutes be dis- 
pensed with and that the minutes, as printed in the 
Transactions, be approved. 



40 MEDICAL SOCIETY OF NEW JERSEY. 

The Secretary asked that the following corrections be 

made before the minutes were approved, viz. : 
(i) On page 34, line 29, omit the name of Henry C. Cook. 

(2) At the bottom of page 17, etc., insert ** f. Delinquent,'* as 
explanatory of the names marked with a cross. This is necessary in 
order that the apparent discrepancy between the totals of the mem- 
bership lists and the totals of the receipts reported from the different 
county treasurers may be explained. 

(3) In the list of honorary members omit the * before the name 
of Virgil M. D. Marcy. 

The minutes as thus amended were then approved. 

The Secretary announced that the following nominees 
for Permanent delegates had presented credentials and 
were recommended for election : B. D. Evans, of Morris 
County; Cyrus Knecht, of Monmouth County; Joseph 
Tomlinson, of Cumberland County; H. B. Costill, of 
Mercer County and J. M. Reese, of Warren County. 

On motion, the Secretary cast a ballot for their elec- 
tion. They were declared elected. 

On motion of the Secretary, action on the names of 
other permanent delegates was postponed until later in 
the session in order to allow of their presenting their 
credentials in proper form. 

Dr. Ryerson : I move that each delegation from the 
different county societies be instructed to report the 
name of their nominee for the nominating committee on 
Wednesday afternoon. 

Dr. M. Lampson : In seconding the motion, I desire 
to say that I consider this a very highly desirable thing 
to do, for in former years the reports have been behind 
time, with the result that there have been what might be 
called snap judgments. I think it is a very good idea, 
therefore, to postpone this matter. 

Dr. C.J. Kipp, Newark: The custom has heretofore 
prevailed of nominating on the first day, but that was 



MINUTES. 41 

when we had two-day meetings. Now that we have 
meetings lasting three days it is far better to postpone 
this matter to the time mentioned in this motion. 

The motion was then carried. 

The Secretary : Charges of unprofessional conduct 
have been preferred against a member of the Monmouth 
County Society, and the matter has been referred to this 
Society for adjudication. According to the by-laws this 
must be referred to the Standing Committee. 

The Chairman : It will be so referred. 

Dr. Henry Mitchell, Asbury Park: I move that the 
matter referred to this Society by the District Society of 
Monmouth, i, e,, the charges against Dr. D. McLean 
Forman, be referred to the Standing Committee of 
Ethics for investigation, said Committee to report their 
findings at the annual meeting of this Society in 1903. 
Seconded and carried. 

The report from the Committee on Ethics and Judicial 
Business being called for, Dr. H. VV. Elmer, the Chair- 
man, stated that the Committee had nothing to report. 

Dr. H. Genet Taylor, Camden, presented the report of 
the Committee on Honorary Membership.* 

On motion, the report was accepted. 

Dr. Philip Marvel, Atlantic City : I move that the 
Society proceed to the election of Dr. J. Leonard 
Corning as honorary member. Seconded by Dr. C. J. 
Kipp and carried. 

On motion of Dr. C. J. Kipp, it was unanimously voted 
that the Secretary cast the ballot of the Society for his 
election. This was done, and he was declared elected. 

The name of Dr. John Allan Wyeth, New York, was 
proposed for honorary membership. 



All reports, papers, etr,, marked thus (*) will be found in the Appendix. 



42 MEDICAL SOCIETY OF NEW JERSEY. 

Dr. C. J. Kipp said : Dr. Wycth is a resident of New 
Jersey for several months of each year, and has a hos- 
pital position. 

Dr. Philip Marvel : I would say that Dr. Wyeth re- 
cently told me that as he was a resident of the State of 
New Jersey for a part of the year he would be pleased if 
elected to membership in the State Society. 

Dr. H. W. Elmer, Bridgeton : I nominate a physician 
who has shown his interest in New Jersey and in the 
welfare of its State Medical Society, i. e.. Dr. Lawrence J. 
Frick, Philadelphia. He has interested himself very largely 
in securing the passage of the bill for the establishment 
of a sanatorium for tuberculosis. 

The Chairman : This will be referred to the Regular 
Committee. 

Dr. M. Lampson : I should like to nominate a gen 
tleman who has shed great lustre on the medical pro- 
fession, particularly in the military service. He has 
served long and faithfully in the United States Navy, 
and was an ornament to the medical department in the 
late war with Spain. I present the name of Rear 
Admiral Van Ruypen, U. S. N., for honorary membership 
in this Society. 

The Chairman : This will be referred to the Regular 
Committee. 

Dr. L. M. Halsey, Williamstown : I move that we 
hear now the report of the delegates to the American 
Medical Association. 

Dr. C. J. Kipp presented this report.* 

On motion, the report was received. 

Reports from delegates to other State societies were 
called for, but no one reported. 



All reports, papers, etc., marked thus (*) will be found in the Appendix. 



MINUTES. 43 

Dn George F. Reading, Woodbury, read the report of 
the Committee on State Sanatoria for Tuberculosis.* 

Dr. M. Lampson : I move the acceptance of the 
report. 

Dr. C. J. Kipp, in seconding, made some interesting 
statements.* 

The report was then accepted. 

Dr. Henry Mitchell, Asbury Park, introduced the fol- 
lowing resolution : 

Resolved, That the Committee on Legislation be and hereby are 
instructed to use every endeavor in the name of this Society to secure 
an additional appropriation by the Legislature in such sums as, in the 
judgment of the Board of Managers of the New Jersey Sanatorium 
for Tuberculosis, may be necessary for the maintenance as well as for 
the erection of the institution under their charge. 

Seconded by Dr. Ceorge E. Reading, Woodbury. 

Dr. E. L. B. Godfrey, Camden: I move to amend by 
referring to the Committee on Legislation. The motion 
was adopted as amended. 

Dr. L. M. Halsey, Williamstown : I move that a vote 
of thanks be oflfered to Mr. John G. Horner, for his ex- 
cellent services in the matter of securing the passage of 
the bill for the establishment of the State Sanatorium 
for Tuberculosis. 

Dr. E. L. B. Godfrey: I move to amend by adding 
that the Society express to the Governor its appreciation 
of his efforts in this direction. 

Dr. Daniel Strock, Camden : It occurs to me that we 
are discriminating in this resolution. The Society is not 
done going to the Legislature, and to discriminate and 
pick out an individual member of the Legislature, and 
also the Governor, seems to be in bad form. I should 
think the entire Legislature should receive the thanks of 
the Society rather than any particular individual. 

All reports, papers, etc., marked thus (*) will be found ip the Appendix, 



44 MEDICAL SOCIETY OF NEW JERSEY. 

Dr. Henry Mitchell : I move to refer this whole 
matter to a committee of three, to prepare a resolution 
in proper form and introduce it at a later period of this 
meeting. Seconded and accepted by Dr. Godfrey, and 
then carried. 

(The Society neglected to appoint this committee, therefore the President, Dr. 
Godfrey, with the approval of the Executive Committee increased the number to 
five and appointed the committe as follows: Drs. Luther M. Halsey, Cornelius 
Shepherd, Richard C. Newton, William P. Watson and W. H. Shipps.) 

Dr. Silvers, Rahway : I would like to ask if the Com- 
mittee on Sanatorium has decided to build a solid struc- 
ture and consolidate those afflicted with pulmonary 
tuberculosis at one point. It is questionable to many 
members of the Society as to the propriety of such con- 
centration. Many think that it would be better to have 
them provided for in each county or in groups of several 
counties. 

Dr. C. J. Kipp : No site has been selected as yet. 

Dr. E. L. B. Godfrey, Camden : I should like in an 
informal way to bring to the attention of the commission 
an excellent site in the pine belt region of Southern New 
Jersey. This region is about twenty miles in width, and 
has a light, porous, sandy soil, which admits of thorough 
drainage. It is also on the watershed between the Dela- 
ware and the ocean. 

Dr. Daniel J. Strock, Camden : I asked the Business 
Committee to permit me to say a few words on the septi- 
caemia clause of accident insurance policies, for, I think 
this is an educational work. I had the misfortune to 
become sceptic last fall, and having been insured in the 
Preferred Accident Insurance Company, of New York. 
With a septicaemia clause especially attached to my 
policy, I felt that I was fully protected. The clause 
reads: ** This policy insures against the effects of blood 
poisoning sustained by a physician, surgeon or dentist, 



MINUTES. 45 

which shall result solely from septic matter introduced 
into the system through any wound received by him 
while performing a professional operation on a person or 
body of some one other than himself." The agent, per- 
haps, does not read that clause to you very carefully, 
but assures you that you are protected against septi- 
caemia. I happened to have a slight abrasion and a 
bruise on my hand, which were not recognized, and I 
thereby became infected. Having become infected, I 
asked for indemnity. I have here the letters sent in 
reply. (Reads them.) The point I wish to make is that 
many physicians probably take accident insurance poli- 
cies largely because they know they are liable to become 
infected in this way, and believing that they will be pro- 
tected by this clause. It should be noted, however, that 
no indemnity will be received unless the sepsis occurs as 
a result of having wounded one's self at the time of an 
operation. One is often unaware of the existence of a 
previous abrasion or scratch, and in any case there is no 
indemnity unless the wound is received at the time of 
doing an operation. It is true that the clause is suffici- 
ently specific, but I am sure that comparatively few fully 
understand this matter. If I can save some one from 
being placed in the same position that I was I shall feel 
that these remarks have not been made in vain. 

Dr. W. J. Chandler, South Orange: It is also the 
ruling of some companies that if the surgeon operates 
upon two cases the same day, and he can not tell from 
which one he received the infection they may decline to 
indemnify him. 

Dr. L. M. Halsey: I move you that the remarks of 
Dr. Strock and Dr. Chandler be published in the Trans- 
actions of our Society. 

The Chairman : They are a part of the record, and a 
motion is not necessarv. 



46 MEDICAL SOCIETY OF NEW JERSEY. 

Dr. C. J. Kipp proposed the following amendment to 
the by-laws, to come up for action next year : 

In By-laws, Chap. V.» Sec. i, 2d, page 33, strike out all after the 
words, *' medical studies," and substitute " in some medical college 
whose requirements do not fall below the minimum standard of the 
Association of American Medical Colleges." 

The portion of the paragraph amended will then read as follows : 
" and has pursued his medical studies in some medical college whose 
requirements do not fall below the minimum standard of the Associ- 
ation of American Medical Colleges." 

Dr. Philip Marvel : I should like to know whether 
the law regulating the practice of medicine in the State 
does not make this part of our by-laws obsolete. As I 
understand it, this State Society cannot grant a diploma 
which will entitle the holder to practice medicine. 

Dr. C. J. Kipp : A gentleman comes up before us to- 
day or to-morrow having a license from the State Board. 
He has had three courses of study, but has not the 
degree of " M.D." and can not, therefore, become a 
member of a county society. I believe this is almost the 
only State Society which now has the authority to grant 
the degree of " M.D." 

Dr. Henry Mitchell read the report of the Committee 
on Legislative Action on Bovine Tuberculosis.* 

On motion of Dr. M. Lampson the report was received. 

Dr. George E. Reading, Woodbury, as the delegate 
to the National Committee on Legislation of the Amer- 
ican Medical Association, presented a report.* 

On motion of Dr. L. M. Halsey the report was 
accepted. 

Dr. Philip Marvel, Atlantic City, introduced the fol- 
lowing resolution : 

Resolved^ That the Committee on Legislation be requested to 
ascertain from the secretaries of the several county societies of New 



All reports, papers, etc., marked thus (*) will be found in the Appendix. 



MINUTES. 47 

Jersey, and otherwise, as seems proper, the number of practising 
physicians of the several counties who are not members of their 
county societies, and also the number of illegal practitioners of said 
counties, and report the same at the next annual meeting. 

Seconded by Dr. L. M. Halsey. 

Dr. Henry Chavanne, Salem : I should like to call at- 
tention of the Society to the lack of loyalty among 
members exhibited when the county society secretaries 
ask for this kind of information. If the members would 
look about them and ascertain just what kind of men are 
practising about them, they would be able to furnish just 
this information. 

Dr. George E. Reading, Woodbury : We get that in- 
formation in our district society, and as a result of this 
we have been instrumental in causing the speedy removal 
of an illegal practitioner from our county. 

Dr. Philip Marvel : There is a wider purpose in this 
resolution, /. ^., that when individuals who are practising 
medicine and have a right to do so, see that the State 
Society has an interest in them it will stimulate an inter- 
est in them, and they will become members of our county 
and State societies. The resolution was then adopted. 

Dr. T. Y. Sutphen, Newark, presented the report of 
the Committee on Abuse of Medical Charities.* 

Dr. W. J. Chandler, South Orange: I move that the 
report be received with the thanks of the Society. Sec- 
onded by Dr. Halsey and carried. 

On motion, adjourned at 12.25 P. M. 



AFTERNOON SESSION. 

The President called the Society to order at 3 P. M., 
and the session was opened with prayer by Rev. William 
Aikman, of Atlantic City. 

AH reports, papers, etc. marked thus (*) will be found in the Appendix. 



48 MEDICAL SOCIETY OF NEW JERSEY. 

Alderman Miller, of Atlantic City, made the following 

address of welcome : 

I am here in the absence of our Mayor, Hon. Franklin P. Stoy. He 
wished me to express his deep regret at not being able to be present. 
The reason he is not here is because he is performing a similar duty 
to what you are doing, /. e., attending a convention in the City of 
Boston. I know if he were here he would say to you : '• Members 
of the Medical Society of New Jersey, you are welcome to our beauti- 
ful city by the sea. You have always been welcome, and you will 
always be welcome. I know you will bear me out when I say there 
was a time when we had to bid for your coming to Atlantic City, but 
that time has gone by, and you have proved your love for our city 
from the fact that you come to see us often, and hold your conven- 
tions here. I assure you all we are glad to have you come here as 
often as F can persuade you to do so. If there is anything that the 
city authorities can do to assist you, all that you have to do is to call 
upon us, and wc will do our best. I trust you will have a very suc- 
cessful meeting as well as a good time during your stay here. I wish 
from the bottom of my heart that the Medical Society of New Jersey 
shall be as successful in the future as it has been in the past. Ladies 
and gentlemen, I thank you." 

Dr. W. B. Stewart, Atlantic City, Chairman, presented 
the report of the Committee of Arrangements.* 

Dr. Philip Marvel : We have with us a gentleman 
from Memphis, Tenn., who is the ex-chairman of the 
Section on Practice of the American Medical Association. 
I take pleasure in nominating Dr. Jones, of Memphis, 
Tenn., as a corresponding member of this Society during 
this annual session. Seconded and carried unanimously. 

Dr. W. B. Johnson, Chairman, presented the report of 
the Committee on Business."^ 

On motion, the report was accepted. 

Dr. E. W. Hedges, Plainfield, presented the report of 
the Corresponding Secretary.* 

On motion of Dr. L. M. Halsey, it was accepted. 



All reports, papers, etc., marked thus (*) will be found in the Appendix. 



MINUTES. 49 

Dr. William J. Chandler, South Orange, presented the 
report of the Recording Secretary.* 

On motion, the report was accepted. 

Dr. Archibald Mercer, Newark, presented the report of 
the Treasurer.* Dr. Mercer recommended that the 
assessment for the ensuing year be one dollar on each 
member of the District Societies, and that the following 
bills be paid : Dr. E. W. Hedges, Corresponding Secre- 
tary, $14.50; Dr. H. W. Elmer, Chairman of Standing 
Committee, $16.75; Dr. W. J. Chandler, Recording Sec- 
retary, $65.52 ; Dr. Archibald Mercer, Treasurer, $17.36; 
Dr. George E. Reading, Committee on Rational Legisla- 
tion, $10.85 J Dr. H. W. Elmer, Tuberculosis Sanatorium 
Committee, $136.65 ; The Orange Chronicle Co., $45.80*; 
The Whitehead & Hoag Co., $40; Dr. L. M. Halsey, 
Legislative Committee, $1. He also moved that the 
bills for Dr. O. C. Ludlow, stenographer, and forthe pub- 
lication of the Transactions be ordered paid. 

Dr. C. J. Kipp: I move the adoption of the report 
and of the recommendations of the Treasurer. Seconded 
and carried. ^ 

Dr. C. J. Kipp: I move that the chairmen of the 
committees present a detailed statement of the expenses 
of the committees and that they shall be paid by the 
Treasurer. Seconded by Dr. C. Shepherd, Trenton. 

Dr. A. Mercer, Newark: Heretofore the Society has 
not paid the necessary traveling and hotel expenses of 
members of committees, yet I think it is only just that 
this be done. 

Dr. Shepherd : I seconded the motion, and I hope it 
will pass. It has never been my fortune to serve on a 
conimittee where I incurred any expense. I served, to a 
certain extent upon the committee which is about to pre- 

* All reports, papers, etc., marked thus (*) will be found in the Appendix. - 



so MEDICAL SOCIETY OF NEW JERSEY. 

sent its report for remuneration, and I think it is entitled 
to it, just as I think is the case with every committee 
acting as an agent of this Society. I hope there will be 
no opposition to the payment of the bills. 

Dr. Rector, Jersey City : I move to amend the motion 
so that the expenses of all the committees be paid. The 
amendment was accepted by Dr. Kipp, and the motion, 
as amended, was carried. 

The following w ere appoi nted on the Auditing Com- 
mittee: Drs. Mfi^w©$[s^*^j£&>sA. Pulsford and B. A. 
Waddington./^^ ^^^^ 

Dr. DaniellSpTO£l^jGa^de;n: I '^ki to call attention 
to the resolufc#i passed this^motning regarding the hand- 
ing in of the nanifcs. to-morrow aiieTnoon, to the Nomi- 
nating Committee. -{f^ifirfdj on Consultation with other 
members, that this Committee cannot conveniently meet 
to-morrow evening. I move a reconsideration of the 
former motion, in order that the names be handed in this 
evening. Seconded and carried. Some desultory discus- 
sion followed. 

Dr. W. J. Chandler: I rise to^a point of order. A 
motion to reconsider has been made, and this reopens 
the original question. 

The Chairman : The point of order is well taken. 
This brings up the original motion of Dr. Ryerson, which 
was then read. 

Dr. L. M. Halsey offered an amendment and moved 
that the names be handed in as soon as possible and that 
the Nominating Committee meet to-night. Seconded 
and the amendment was carried. Then the motion, as 
amended, was carried. 

Dr. D. Strock: The Librarian of the Philadelphia 
Law Library expressed the desire that the library receive 
a copy of the Transactions of the Society from year to 



MINUTES. SI 

year. I move * that hereafter a copy of the Trans- 
actions of the Society be transmitted to the Philadelphia 
Law Library. Seconded and carried. 

Dr. R. C. Newton, Montclair, presented the report of 
the Committee on Milk as a Food and a Means of Con- 
tagion.* 

On motion of Dr. N. L. Wilson, Elizabeth, the report 
was received and its recommendations adopted. 

Dr. H. W. Elmer presented an itemized bill of expenses 
of the Committee on Tuberculosis. On motion of Dr. 
T. R. Chambers, Jersey City, the Society ordered this 
bill paid. 

The Auditing Committee reported that they had exam- 
ined the books and vouchers of the Treasurer and found 
the same correct and in order. On motion, the report 
was received. 

On motion of Dr. C. J. Kipp, the Society called for the 
report of the Committee on Revision of By-Laws. Dr. 
Philip Marvel presented this report. 

Dr. C. Shepherd, Trenton : I move that this report be 
received and printed in the Transactions. Seconded. 

Dr. Kipp : We have no constitution at present. This 
Society is working under a charter, and we cannot change 
the charter without going to the Legislature. We can 
retain our charter, I am informed, and make the altera- 
tions suggested by this committee, but in order to do this 
we must employ a first-class lawyer. We have absolutely 
no right at present to make the members of County 
Societies members of this Society. I therefore move that 
this committee, which has under consideration the revi- 
sion of the by-laws, be continued for another year and be 
empowered to employ counsel to adjust this matter. 

Dr. C. Shepherd : I accept this as part of my motion. 

All reports, papers, etc., marked thus (*) will be found in the Appendix. 



52 MEDICAL SOCIETY OF NEW JERSEY. 

Dr. David C. English, New Brunswick: I move as an 
amendment that the report be printed in pamphlet form, 
and in quantity sufficient ta supply each member of the 
district societies. There is no need for placing this in 
permanent form. We have been tinkering with our con- 
stitution for ten or fifteen years; let us proceed this time 
in a deliberate way, and if the report be printed in 
pamphlet form it will not cost much, and we will be fully 
prepared next year to take action that will not consume 
hours. Seconded. 

Dr. H. Chavanne, Salem : I believe that is all that is 
necessary to bring this matter before the Society. I can- 
not see that the work of this committee interferes at all 
with the charter of this Society, for the reason that we 
are not adopting anything. If printed in the Trans- 
actions it may induce all of the members to read the 
Transactions, which they might not otherwise do. The 
continuation of the committee for another year for the 
purpose of consulting legal authorities, would mean that 
we must wait another year before adopting it. If printed 
in the Transactions it could be corrected by legal coun- 
sel and the corrections presented to us with a report next 
year. We could then act upon it at once. In this w^ay 
we would save a year. I should like Dr. Shepherd's 
original motion to prevail. 

Dr. A. Treganowan, South Amboy : I am a member 
of that committee and I think if the motion were made 
to continue that committee, then the committee would 
be in a position to offer some kind of a reasonable report. 
If. I understand it. Dr. Marvel offered this as a report of 
progress, with the intention that the committee would be 
continued. The constitution and by-laws require amend- 
ing- itjvqry. many particulars. -This committee is formed 
of five^ one living in. Atlantic City^ another in Jersey 



MINUTES. 53 

City, another in Trenton and another in South Amboy, 
and we are not conveniently situated for conference. In 
spite of this, during the last four months we have had 
five meetings ; yet, even with this work, we feel that we 
have not had sufficient time to sublimate this matter, and 
I think the committee should be continued so that it 
may present next year a concrete report for action. 

Dr. T. R. Chambers : I call for the question on Dr. 
English's amendment. The question was put and the 
amendment was lost. 

Dr. Henry Mitchell, Asbury Park: I move as a sub- 
substitute for Dr. Shepherd's motion, that the report of 
the Committee be accepted with thanks, and that a con 
stitution and by-laws be prepared by them and be printed 
in pamphlet form. Seconded. 

Dr. C. Shepherd : My only object in making that 
motion was that the committee be continued, and that 
they prepare such by-laws with amendments and present 
them to us, either in the Transactions or in pamphlet 
form, so that we may have them in time to examine 
them and act upon them at the next meeting. I did not 
intend that the committee should wait until next meet- 
ing. I therefore am willing to withdraw my motion. 

Dr. Philip Marvel: As Chairman of the committee I 
would say that the committee has prepared a copy of 
the constitution and by-laws which they expected to 
submit to the Society. They have consulted legal 
counsel, but it has been thought wise not to present this 
matter to the Society until it has been printed and dis- 
tributed throughout the county societies and an oppor- 
tunity given each member to prepare himself to vote in- 
telligently at the next meeting. The recommendation 
was that it should be put in the Transactions or in 
pamphlet form, this question to be decided by the 
Society and not by the committee. 



54 MEDICAL SOCIETY OF NEW JERSEY. 

Dr. D. C. English : It does seem to me that there is 
a misunderstanding here. The Chairman says that the 
constitution and by-laws have been prepared, while 
another member of the committee says that they have not. 

Dr. Philip Marvel: It so happened that the other 
member of the committee was not present at the last 
meeting of the committee, and hence the discrepancy. 

Dr. D. C. English : I question very much whether it 
is wise for this, committee to print in pamphlet form or 
in the minutes the revised by-laws in their present shape. 
I would very much prefer that it be referred back to the 
committee, and the committee be instructed to print in 
pamphlet form such report as they intend to present at 
the next annual meeting. 

A vote was then taken on Dr. Mitchell's motion, and 
it was carried. 

Dr. C. J. Kipp: I proposed an amendment to the 
by-laws last year. What has become of it? It should 
come up, I think, for action at this time. I move that 
this amendment be now considered. Seconded and 
carried. The Secretary read the amendments as printed 
in Transactions of 1901, page 64. 

Dr. Philip Marvel: I do not wish to anticipate this 
amendment in any way, but I do desire to say that this 
matter is under consideration by the Committee on Re- 
vision, and I have been informed by legal counsel that it 
is necessary to have a Board of Trustees as we are an in? 
corporated body. This has been considered in our new 
constitution and by-laws, and we expect that the Fellows 
will constitute the Board of Trustees. There will be a 
Business Committee which will continuously sit during 
the time of the meeting, and to this any matter may be 
referred with power to act. This, I think, takes the 
place of the amendment now before you. 



MINUTES. 55 

Dr. Kipp: I move that this amendment be adopted. 
Seconded. 

Dr. C. Shepherd, Trenton : I think it is useless for us 
at this stage to attempt to amend our by-laws. 

Dr. W. J. Chandler, South Orange: Under the 
present arrangement the Secretary is the only one who 
can act during the intervals between the annual meetings, 
and I should be in favor of this amendment, even though 
it exists for only one year. 

Dr. E. W. Hedges, Plainfield: Dr. Chandler has done 
the work of the Society satisfactorily for a number of 
years, and I think we can trust him to continue as before 
for another year. A vote was then taken on the pro- 
posed amendment, and it was lost. 

Dr. Philip Marvel : As a member of the Committee on 
Revision I desire to move that three members be added 
to this committee. Seconded and carried. 

Dr. Philip Marvel : I move that the Executive Com- 
mittee be appointed by the Chair for one year, the same 
to consist of the Officers of the Society and of three 
Fellows. Seconded by Dr. Kipp and carried. 

The Secretary : Dr. David Stevens, of Middlesex 
County, has presented a piece of parchment relating to 
the early history of this Society. I move that the copy* 
of the letter accompanying this relic be published in the 
Transactions, and that the thanks of the Society be ex- 
tended to Dr. Stevens for this gift. Carried. 

The Secretary read a communication from the New 
Jersey State Association of Nurses.* He then moved 
the adoption of the following resolution : 

Resolved, That we are in sympathy with the efforts of the nurses 
to establish a legally organized body, and approve of the objects of 
their association. 

Seconded and carried. 



All reports, papers, etc., marked thus (*) will be found in the Appendix. 



56 MEDICAL SOCIETY OF NEW JERSEY. 

On motion of Dr. D. Strode, the Secretary cast a ballot 
for the election as Permanent Delegates of Dr. George 
N. Best, of Rosemont, and Dr. Mary E. Gaston, of 
Somerville. 

On motion, adjourned at 5 P. M. 



EVENING SESSION. 

The meeting was called to order by the First Vice- 
President, Dr. E. L. B. Godfrey, at 8.30 P. M. The 
President, Dr. John D. McGill, then delivered his address, 
taking as his theme, " The Nervous System in its Rela- 
tions to Medico-Legal Medicine.*** 

Dr. Walter B. Johnson : I move that the thanks of 
the Society be extended to. Dr. McGill and that the 
address take the usual course. Seconded and carried. 

The names of the Nominating Committee were then 
announced, as follows : 

Nominating Committee. 

Atiantzc—\i. C. Pennington ; Bergen — D. A. Currie ; Burlington — 

R. H. Parsons; Camden — Daniel Strock ; Cumberland — T.G.Davis; 

Essex — Chas. J. Kipp ; Gloucester — L. M. Halsey ; Hudson — Henry 

H. Brinkerhoff ; Hunterdon — Geo. L. Romaine; Mercer — Elmer 

Barwis ; Middlesex — Frank M. Donahue; Monmouth — F. C. Price; 

Morris— K, A. Lewis ; Passaic — J. L. Leal ; Salem — Henry Chavanne; 

Somerset — J. H. Buchanan; Union— WcXox Mravlag; Warden — 

J. M. Reese. 

Chas. J. ICipp, Chairman, 

Dr. H. W. Elmer, Bridgeton, Chairman of the Stand- 
ing Committee, presented the report of that committee.* 
On motion, the thanks of the Society were tendered to 
Dr. Elmer for his very able and interesting report. 

AH reports, papers, etc.. marked thus \*) will be found in the Appendix, 



MINUTES. 57 

Dr. W. B. Johnson presented Dr. C. P. Noble, of Phil- 
adelphia, and moved that he be made a corresponding 
member for this annual meeting. 

Dr. Philip Marvel made the same motion with regard 
to Dr. Rodman, of Philadelphia. Both motions were 
unanimously carried. 

Dr. Edward E. Worl, Newark, presented the report on 
" Progress in State Medicine and Hygiene.*'* 

On motion, the report was accepted and referred to the 
Standing Committee. 

Dr. Elmer announced that Dr. Charles Young had been 
detained by court business and desired that his paper on 
*' Progress in Surgery "* be read by title. 

On motion of Dr. D. C. English, the paper of Dr. Young 
was ordered read by title, and was referred to the Stand- 
ing Committee. 

Dr. B. A. Waddington, Salem, read the report on *' Pro- 
gress in Diseases of the Nose and Throat."* 

On motion of Dr. D. C. English, the report was accepted 
and referred to the Committee on Publication. 

Dr. Talbot. R. Chambers, Jersey City, presented the 
report on '* Progress in Diseases of the Eye and Ear."* 

On motion of Dr. W. B. Johnson, the report took the 
usual course, and the thanks of the Society were extended 
to Dr. Chambers. 

Dr. Mazyck P. Ravenel, of the University of Pennsylva- 
nia, presented the report on ** Progress in Bacteriology."* 

The Chairman thanked the author in the name of the 
Society. 

Dr. Philander A. Harris, Paterson, presented a report, 
'* Some Diseases of the Fallopian Tubes,"* with lantern 
slides. 

On motion, the thanks of the Society were extended 
to Dr. Harris, and the paper took the usual course. 

All reports, papers, etc., marked thus (*) will be found in the Appendix. 



58 MEDICAL SOCIETY OF NEW JERSEY. 

Dr. George E. McLaughlin, Jersey City, presented a 
paper on **The Pathology of Appendicitis,"* with lantern 
demonstration. 

On motion, the thanks of the Society were extended 
to Dr. McLaughlin for his exceedingly instructive lecture. 

On motion, the Society adjourned at 11.30 P. M. 



SECOND DAY— WEDNESDAY, JUNE 25TH. 

MORNING SESSION. 

The meeting was called to order by the President at 
10.00 A. M. 

The Secretary: A candidate for the degree of M.D. 
has appeared before the Essex County Society. He has 
passed a satisfactory examination, and has presented a 
certificate signed by the President of the Essex County 
Society, and a thesis. According to our by-laws, if these 
are satisfactory our Society can grant him a diploma. I 
therefore move that the certificate and thesis be referred 
to a special committee of three, and that they report back 
to the Society the result of their examination. Carried.* 

The Chairman appointed on that committee, Dr. Charles 
D. Bennett of Newark, Dr. Cornelius Shepherd of Tren- 
ton arid Dr. David C. English of New Brunswick. 

The Secretary: The certificate of Dr. A. K. Baldwin 
for permanent delegate has been received. It is approved 
by the Committee on Credentials and he is now eligible 
for election. 

On motion of Dr. D. C. English, the Secretary was 
instructed to deposit the ballot for his election. The 
ballot was cast, and Dr. Baldwin was declared unani- 
mously elected. 

AH reports, papers, etc., marked thus (*) will be found in the Appendix. 



MINUTES. 59 

On motion of Dr. L. M. Halsey, Dr. Joseph E. Gichnir, 
of the University of Maryland, was asked to sit with the 
Society at this meeting as a corresponding member. 

The Secretary read the following : It is moved that it 
shall be the duty of the Executive Committee, in the 
intervals between the meetings of the Medical Society of 
New Jersey, to act for the Society, and this committee is 
hereby authorized to transact any business which, in its 
judgment, requires attention. Seconded and carried. 

Dr. A. W. Taylor, of Beverly, the THird Vice-President, 
presented an essay. **The Rural Surgeon; His Place, 
Privilege and Duty."* It was discussed by Dr. A. Treg. 
anowan. South Amboy, Dr. Corwin, Newark, and Dr. A. 
K. Rogers, Paterson.* 

Dr. Joseph Tomlinson, Bridgeton, presented a paper, 
** The Present Methods of Education from the Standpoint 
of the Physician."* It was discussed by Dr. R. C. 
Newton, Montclair]; Dr. Walter B. Johnson, Paterson ; 
Dr. Dowling Benjamin, Camden; Dr. E. J. Ill, Newark; 
Dr. D. C. English, New Brunswick; Dr. T. J. Smith, 
Bridgeton; Dr. J. H. Pugh, Burlington; Dr. Cornelius 
Shepherd, Trenton, and Dr. Charles Bennett, Newark.* 

Dr. D. C. English : I move that a committee of five 
be appointed to whom this paper shall be referred, and 
that this committee shall report at our next annual meet- 
ing. I should like to see Dr. Tomlinson chairman of that 
committee. Seconded by Dr. T. J. Smith and carried 
unanimously. The following were appointed on this 
committee: Dr. Joseph Tomlinson, Bridgeton; Dr. David 
C. English, New Brunswick ; Dr. E. L. B. Godfrey, Cam- 
den ; Dr. R. C. Newton, Montclair and Dr. W. B. Johnson, 
Paterson. 

Dr. Dowling Benjamin : I move that medical inspec- 

AU reports, papers, etc., marked thus (*) will be found in the Appendix. 



6o MEDICAL SOCIETY OF NEW JERSEY. 

tion be made a special order of business for thirty minutes 
this afternoon at 3 o'clock. Not seconded. 

On motion of Dr. Godfrey, Professor Montgomery, of 
Jefferson Medical College, and Dr. Mordecai Price, of 
Philadelphia, and Dr. William M. Beach, Pittsburg, were 
invited to sit with the Society during this meeting as 
corresponding members. 

Dr. L. M. Halsey presented at this time, by unanimous 
consent, the report of the Committee on Legislation.* 

On motion of Dr. M. Lampson, the report was received, 
its recommendations adopted and the committee con- 
tinued. 

The Secretary explained that the by-laws made it the 
duty of the Secretary of the Society to notify the chair- 
men of committees, the latter being expected to notify 
the members of their respective committees. 

Dr. E. L. B. Godfrey asked permission to resign from 
the Committee on Legislation in favor of Dr. D. Strock, 
Camden. This was granted. 

Dr. William M. Beach, Pittsburg, presented a paper, 
*' Valvotomy as a Surgical Measure for the Cure of Obsti- 
nate Constipation." It was discussed by Dr. A. K. Rogers, 
Paterson. 

Dr. Emery Marvel, Atlantic City, presented a paper, 
*' Further Report on the Use of Ethyl Bromide as a 
Primary Anaesthesia to Ether."'^ 

Dr. Alexander McAllister, Camden, read a paper, " The 
Cause of Sore Arms during the Recent Vaccinations." 
It was discussed by Dr. A. K. Rogers, Paterson; Dr. A. 
I. Hunt, Hamilton Square, and Dr. Cornelius Shepherd, 
Trenton."^ 

» 

Dr. Dowling Benjamin, Camden, read a paper, " The 
Cure of Cancer by the X-Ray." Discussion by Dr. T. 
R. Chambers, Jersey City.* 

All reports, papers, etc., marked thus (*) will be found in the Appendix. 



MINUTES, 6l 

Dr. F. C. Ard, Plainfield, presented a paper, "Radical 
Operation for the Relief of Chronic Purulent Disease of 
the Middle Ear."* 

On motion, adjourned at i P. M. 



AFTERNOON SESSION. 

The nneeting was called to order by the President at 
3 P. M. 

The Secretary announced that a certificate from Dr. 
Andrew F. McBride, of Paterson, had been received, and 
that he was eligible for election as a Permanent Delegate. 
On motion, the Secretary cast a ballot for his election, 
and he was declared elected. 

Dr. Charles D. Bennett, Newark, presented the report 
of the special committee on the candidate for the degree 
of M.D., as follows: 

The committee appointed to examine the certificate and thesis of 
Dr. Arnheim Fischer, of Newark, recommended for the degree of 
Doctor of Medicine by Essex District Medical Society, report that they 
have examined the papers, find them satisfactory, and recon^mend 
that the degree of Doctor of Medicine be granted to him. 

Charles D. Bennett, 
Cornelius Shepherd, 
David C. English, 

Committee. 

The Secretary : I move that the report be accepted 
and adopted, that the certificate and thesis be placed on 
file, and that the degree of M. Di be conferred upon 
Dr.. Arnheim Fischer, in accordance with the by-laws, aad 
a diploma issued to him. Seconded and carried. On 
motion, the Seci-etary was authorized to cast the ballot 
granting the degree of M.D. to Dr. A. Fischer. This 
was done, and ^ unanimous affirmative votfe announced. 



AUreporty^ papef^, etc.", jnarked thus (*) will bc.found in the Appendix: 



62 MEDICAL SOCIETY OF NEW JERSEY. 

Dr. David C. English presented a report from the 
Fellows.* 

On motion, this report of the Fellows was referred to 
the Publication Committee. 

A communication was presented from Dr. F. H. Wiggin, 
of New York, delegate from the New York State Medical 
Association, expressing his regret at not being able to 
attend. 

Dr. Edward J. Ill, Newark, read a paper, ** The Cause 
and Treatment of Sterility in Women." It was discussed 
by Dr. G. H. Balleray, Paterson, and Dr. W. E. Carroll, 
Newark * 

On motion of Dr. Emery Marvel. Dr. Henry D. Beyea, 
of Philadelphia, was made a corresponding member, and 
was requested to sit with the Society during this annual 
meeting. 

Dr. A. E. McAllister, Camden, presented a paper, 
** Report to the State Society of the Cases of Tetanus 
following Vaccination in Camden." Discussion by Dr. 
Dowling Benjamin, Camden.* 

Dr. George H. Balleray, Paterson, read a paper, **A 
Plea for the Early Diagnosis and Treatment of Cancer of 
the Uterus."* 

Dr. Wells P. Eagleton, Newark, read a paper, ** Brain 
Abscess of Otitic Origin." It was discussed by Dr. W. B. 
Johnson, Paterson, and Dr. T. R. Chambers, Jersey City.* 

Dr. Talbot R. Chambers, Jersey City, presented a 
paper,* " Further Notes on the Hot Water Douche for 
Aborting Mastoiditis." It was discussed by Dr. W. B. 
Johnson, Paterson, Dr. N. L. Wilson, Elizabeth, and Dr. 
Cornelius Shepherd, Trenton, and the discussion was 
closed by Dr. Chambers.* 

Dr. H. D. Beyea, of Philadelphia, read a paper,* ** The 

All reports, papers, etc., marked thus (*) will be found in the Appendix. 



MINUTES. 63 

Surgical Treatment of Gastroptosis." Discussion by Dr. 
Emery Marvel, Atlantic City, Dr. M. Lampson, Jersey 
City, Dr. Philip Marvel, Atlantic City, and Dr. R. C. 
Newton, Montclair, the discussion being closed by Dr. 
Beyea.* 

The following were appointed to serve with the officers 
of the Society on the Executive Committee : Dr. C. J. 
Kipp, Newark, Dr. William Elmer, Trenton, and Dr. 
C. R. P. Fisher, Bound Brook. 

The following were added to the Committee on Re- 
vision of by-laws by resolution of the Society ; Dr. D. 
C. English; Dr. Henry VV. Elmer and Dr. Henry 
Mitchell. 

On motion, adjourned at 5.40 P. M. 

■ 

The evening was taken up with a reception and 
a smoker. 



THIRD DAY— THURSDAY, JUNE 26TH. 

The meeting was called to order by the President at 
9.25 A. M. 

Dr. Dowling Benjamin, Camden, exhibited ** A New 
Obstetrical Forceps."* 

The ** Report of a Case of Intestinal Obstruction "* by 
Dr. E. A. Y. Schellenger, of Camden, was ordered read 
by title. 

The question proposed by the Business Committee for 
discussion was : ** What are the best methods to prevent 
the spread of Tuberculosis? *' There was no discussion 
upon it. 

Dr. George E. Reading, Woodbury, presented a paper 
** A Report of a case of Tumor of the Orbit."* 

All reports, papers, etc., marked thus (*) will be found in the Appendix. 



64 MEDICAL SOCIETY OF NEW JERSEY. 

On motion of Dr. E. L. B. Godfrey, the paper was 
transmitted to the Standing Committee for publication 
in the Transactions. 

The Report of the Committee on Nominations was 
read by the Secretary, as follows : 

To the Medical Society of New Jersey : 

Gentlemev: —Your Nominating Committee respectfully submit 
the following names for their respective offices for 1903: 

President — E. L. B. Godfrey, of Camden. 

First Vice-President — Henry Mitchell, of Asbury Park. 

Second Vice-President — A. VV. Taylor, Beverly. 

Third Vice-President — Walter B. Johnson, of Paterson. 

Corresponding Secretary — E. W. Hedges, of Plainfield. 

Recording Secretary— ^WWdun J. Chandler, of South Orange. 

Treasurer — Archibald Mercer, of Newark. 

Standing Committee — Henry W. Elmer, Bridgeton ; B. A. Wad- 
dington, Salem. 

Business Committee — Alexander McAllister, Camden ; B. C. 
Pennington, Atlantic City ; E. HoUingshead, Pemberton ; Joseph M. 
Rector, Jersey City ; George H. Franklin, Hightstown. 

Committee on Honorary Members — H. Genet Taylor, Camden ; 
Alexander \V. Rogers, Paterson ; Charles J. Kipp, Newark. 

Committee of Arrangements— John Taiylor, Ocean Grove; Samuel 
Johnson, Asbury Park ; J. F. Davison, Asbury Park ; Edgar Roberts, 
Keyport ; Henry Mitchell, Asbury Park ; George F. Wilbur, Asbury 
Park; George E. Reading, Woodbury. 

Delegates to American Medical Association -L. M. Halsey, 
Willia:n5town ; W. F. Faison, Jersey City, alternate. 

Delegate to International Medical Congress, Madrid— ^\\2s\t^ J. 
Kipp, Newark, with power to name alternate. 

Delegates to New York Medical Society —William J. Chandler, 
South Orange; D. A. Currie, Englewood ; U. Allen, Jersey City. 

Delegates to New Hampshire Medical Society— r-Y.^^vs\ Field, Red 
Bank ; J. G. Ryerson, Boonton ; S. O. B. Taylor, Millstone. 

Delegates to Connecticut Medical Socigty — J. A. Exton, Arlington ; 
S. A. Heifer, Hoboken. 

Delegates to ^ Rhode Island Medical Society —Pl. J. Alexander, 
Paterson ; M. S. Ayres, Fairview. 



MINUTES. 65 

Delegates to Maryland Medical Society—^, M. Curts, Paterson ; 
T. G. Davis, Bridgeton ; William H. Iszard. Camden. 

Delegates to Ddaware Medical Society — Charles S. Heritage, 
Glassboro ; E. E. DeGrofft, Woodstown ; William A. Davis. Camden. 

Delegates to Mississippi Valley Medical Association — William F. 
Faison, Jersey City ; J. T. Gilson, Paterson ; George E. Reading, 
Woodbury. 

Delegates to Massachusetts Medical Society — F, H. Todd, Pater- 
son ; T. J. Fitzmaurice, Paterson ; S. A. Heifer, Hoboken ; W. R. 
Kinmouth, Farmingdale. 

Delegates to American Pharmaceutical Association —V^ . K. 
Newton, Paterson ; H. L. Coit, Newark. 

Delegates to Pennsylvania Medical Society — William S. Jones, 
Camden ; H. H. Lucas, Paterson ; H. A. Wilson, Woodbury ; Cor- 
nelius Shepherd, Trenton ; Daniel Stout, Berlin ; J. F. Leavitt, 
Camden. 

Asbury Park selected as place of meetihg for 1903. 

Signed, CHARLES J. Kipp, Chairman, 

• H. H. Brinkerhoff, Secretary, 

Dr. M. Lampson : I move that the report of the Com- 
mittee on Nominations be received. Seconded and 
carried. 

Dr. Lampson : I move that the Secretary . be in- 
structed to cast the ballot of the Society for the nomi- 
nations presented in this report of the committee. Sec- 
onded and carried. The Secretary cast the ballot and 
the announcement was made that these nominees had 
been duly elected. 

Dr. George E. Reading : I move that the Committee 
of Arrangements be authorized to secure suitable badges 
for the next meeting at a cost not to exceed fifty dollars. 
Seconded and carried. 

Dr. Dowling Benjamin : I wish to call the attention 

of the Society to a state of things which demands our 

consideration. The State of New Jersey lies between 

two great medical centres, and I understand that both 

5 



66 MEDICAL SOCIETY OF NEW JERSEY. 

Pennsylvania and New York refuse to register any doctor 
from Camden, N. J., who passes the- New Jersey Board 
and goes with a certificate licensing him to practice in 
the State of New Jersey. We are accepting all those 
coming into New Jersey with the certificates from these 
other states. If no examination is made they are 
charged fifty dollars; if they are examined, the price is 
half. I do not think they should be charged so much 
when not examined. I also think that the fee system 
should be changed and salaries adopted. Most of the 
physicians practicing in New Jersey are dissatisfied and 
think if the New Jersey State examinations are not of 
the same standard as the other states mentioned, they 
should be made so, or at least uniformity of require- 
ments in the three States should be secured. I think 
this Society should urge upon the Legislature or upon 
the Examining Board to make some clfange in tliis 
direction. 

Dr. E. L. B. Godfrey, Camden : The Doctor's state- 
ments are very misleading, and his suggestion recalls the 
fact that a spirit of retaliation has been just inaugurated 
in our Supreme Court. I have given this matter consider- 
able thought, and after an experience of five years have 
reached the conclusion that any physician who possesses 
an academic education equivalent to our high schools, 
who has studied medicine four years and is a graduate of 
a duly licensed medical college, and who, in addition to 
these requirements has passed a State examination and 
attained a general average of 75 per cent., should be 
indorsed by this State. We have refused to indorse 
applicants from New York because they could not meet 
our requirements. We have refused five this year from 
Pennsylvania who could not meet the academic require- 
ments of our board. We will indorse anyone who can 



MINUTES. 67 

meet the academic, the- medical and examining require- 
ments of our board, no matter from where he comes. As 
a result of this, inter-state indorsement has taken a step in 
advance. Within the past six moxJths Maine has agreed 
to receive certificates of New Jersey, so also have Dela- 
ware, Maryland, Virginia, West Virginia and Illinois, and 
I think Ohio and Wisconsin will do the same. This will be 
satisfactorily worked out in time. If it were not for our 
State Board I think we would have more than one thou- 
sand physicians registered within a year. Even this year 
the board has been obliged to refuse to admit to exami- 
nation some fifty-seven physicians from Baltimore, 
Chicago and other places because they did not meet our 
requirements. There can be no doubt about the que&n 
tion that if candidates can meet all the requirements :(>f- 
our law they should be admitted. It is absolutely impos- 
sible for the candidate to get before the State Board ot 
Examiners unless he can say by af5fidavit and by indorse- 
ment from his college that he has had a medical educa- 
tion of four years. We claim to be in advance in this 
respect of any State Board in this country. The reason 
New York will not indorse ours is that their academic 
course is of a higher grade, though their medical require- 
ments are not. Moreover, their requirements are by 
statute, while ours are by resolution of the board. 

Dr. George E. Reading: This recalls to my mind a 
matter taken up in the legislative conference last April. 
It was there recommended that the American Medical 
Association take steps to promote reciprocity between the 
States in this matter. It was thought that the require- 
ments of the various States should be brought to one level, 
and that then reciprocity between all of the States should 
be accomplished. I believe, as Dr. Godfrey has stated, 
that this is being gradually accomplished now. I am also 



68 MEDICAL SOCIETY OF NEW JERSEY. 

reminded that Dr. Rodman told me yesterday that he 
had been informed by the President of the American 
Medical Association that the Committee on National 
Legislation would be continued, and if this is true our 
Society should elect a delegate to be present at this con- 
ference when it is called. This conference has been the 
means of doing a great deal of good and bringing a great 
deal of influence to bear upon matters brought before 
Congress which concern the medical profession. 

Dr. Dowling Benjamin : The answer of Dr. Godfrey 
has practically no relation to the facts I mentioned, and 
does not mitigate the conditions or excuse them. In 
order to see what our examiners want, I move that it is 
the sense of this Society that we should not accept the 
certificates of States who refuse to accept ours. Seconded. 

Dr. C. Shepherd : I was about to suggest that this 
whole matter be referred, with power to act, to our 
Examining Committee. It is a matter, so far as I am 
concerned as an individual, of no importance, but it is a 
matter of the gravest importance to many physicians, not 
only in our State but in neighboring States. Inasmuch 
as we are about arranging a new set of by-laws and a new 
constitution, and that constitution being of the oldest 
State Medical Society in this country, this committee 
should exercise every effort to make these by-laws and 
constitution not only a model for the State of New Jersey, 
but for all the other States in the United States, and 
that when it is completed it will conform to the require- 
ments of the American Medical Association, and that all 
of the county societies will be required to conform to the 
new by-laws and constitution of the Medical Society of 
New Jersey. When this has been accomplished, our 
Board of Examiners should be authorized to communicate 
with every State Medical Society in this country, and, if 



MINUTES. 69 

possible, make arrangements by which graduates, and 
those reciving certificates from the Examining Board of 
this State, shall be received and permitted to practice 
medicine in any other State. Such an arrangement, I 
think, should be established, and should be uniformly 
adopted by every State Medical Society of the United 
States. Pennsylvania is my native State, and I hope 
that Pennsylvania will soon recognize the importance of 
receiving those who have graduated in her own schools 
in Philadelphia, and who have received certificates from 
our State if they desire to practice medicine in Penn- 
sylvania. I hope that this Society will instruct the 
committee on examinations at this time to make this 
arrangement, if possible. 

Dr. Dowling Benjamin : I do not think Pennsylvania 
will ever do that, for the reason that Pennsylvania would 
not receive any of the teachers* certificates from New 
Jersey until our State stopped their teachers from coming 
over here; then they received them. 

Dr. E. L. B. Godfrey: It seems impossible to get the 
facts fairly into Dr. Benjamin's mind. To refuse candi- 
dates from Pennsylvania, New York, or any other State, 
simply because they refuse to accept candidates having 
licenses from New Jersey is simply acting, we must admit, 
from purely selfish motives, and on this ground no progress 
can be made. The progress which we have made in this 
State is tremendous, and it comes after five years of 
experience. I would rather resign from the board than 
go back to the selfish plan of not indorsing those from 
other States simply because other States refuse to indorse 
our licenses. Within six months Maine, Delaware, Mary- 
land, Virginia, West Virginia and Illinois have accepted, 
without conditions, the certificate from New Jersey. We 
exact four conditions before we accept a certificate from 



70 MEDICAL SOCIETV OF NEW JERSEY. 

any other State, viz. : (i) Certain academic require- 
ments; (2) medical study for four years; (3) examina- 
tion in nine branches of medicine and (4) the applicant 
must attain 75 per cent, in the examination. It was 
conceded at Saratoga, I am informed, that our board had 
made further progress than any other State. I have no 
doubt that in the course of a year or two the certificates 
from New Jersey will be indorsed by most of the States. 
It is doubtful if New York will ever do so. If you will 
let the Board of Examiners alone, we will place you in 
advance of any other State in the Union. Dr. Benjamin 
, has been at me for years, and his position is absolutely 
selfish. We absolutely refuse to enter into any conditions 
with Pennsylvania or any other State, preferring to take 
all applicants on their individual merits. 

Dr. M. Lampson: I desire to ask Dr. Godfrey a few 
questions. In the first place, how many men have ap- 
peared before the State Board for the last five years for 
examination that are not graduates of colleges accepted 
and recognized by the American Medical Association ? 

Dr. Godfrey: We have had some this year, I know; 
I can not at this moment answer the question more 
definitely. 

Dr. Lampson : I asked this question because this class 
of men seems to be diminishing, and the tendency seems 
to be to wipe out the lines between so-called regular and 
irregular practitioners. It seems that New York has a 
preliminary education standard fixed by statute, and 
hence the Board of Examiners have no choice. In New 
Jersey it is a matter of the judgment of the board. It is 
a well-known fact that the requirements of New York 
city are higher than elsewhere. 

Dr. E. W. Hedges, Plainfield : It seems to me that 
the stand taken by our State Board of Examiners is 



MINUTES. 71 

logical, clear and very proper. I, for one, would be very 
sorry to see this Society take a step backward by in- 
structing them to do anything different. We are all 
proud, I am sure, of what that board has done in keeping 
out improper practitioners and competitors. Consider- 
ing the progress made by our Board I am sure we should 
uphold them, and be careful to do nothing to hamper 
them. No great reform is accomplished in a short time ; 
we can do more with regard to other Stales by policy 
than by effrontery. Let us trust to what may be called 
the policy of our Hoard. I hope Dr. Benjamin's motion 
will not prevail. 

Dr. A. Treganowan, South Amboy : There is one 
sentence in Dr. Godfrey's remarks which strikes me very 
forcibly, and it pleases me very much. It is directly in 
accord with our national policy ; it accords with the con- 
stitution itself. He said that if an applicant comes up to 
the standard of the requirements it matters not from 
whence he comes whether from abroad or from our own 
country. Then, I say, Godspeed to the board, if this is 
their policy. It is in accordance with our national in- 
dependence. With regard to the remarks of Dr. 
Shepherd concerning the committee appointed to revise 
the constitution and by-laws of this State Society, I can 
assure you that we are advancing. The last revision was 
in 1866, and as Dr. Shepherd justly says, our ideas have 
progressed since that time. It is the intention of the 
committee to oflfer to the Society a revision that will 
suit every condition which may arise. It is our effort to 
present such by-laws and constitution as will meet every 
necessity and will be a little in advance of every other 
such society in the United States. 

A vote was then taken on Dr. Benjamin's motion and 
it was declared lost. 



^2 MEDICAL SOCIETY OF NEW JERSEY. 

Dr. A. McAllister, Camden : I move that we proceed 
to elect a member from this Society to attend the meet- 
ing of the Committee on National Legislation of the 
American Medical Association. Seconded by Dr. H. W. 
Elmer and carried. 

Dr. McAllister : I nominate Dr. George E. Reading, 
Woodbury, as delegate to this meeting. Dr. Reading 
was elected. 

Dr. E. L. B. Godfrey : I regret to announce that I 
have just heard of the death of Dr. Alexander M. 
Mecray, of Camden. He was one of the most popular 
physicians of that city. I move that the Secretary send 
a telegram of condolence to his widow, expressive of the 
regret of this Society at Dr. Mecray 's sudden death. 

Dr. G. E. Reading: I wish to amend this resolution 
by providing that an obituary notice also appear in the 
Transactions. 

The motion, as amended, was unanimously carried. 

Dr. Reading: I move that the time of the next annual 
meeting be the 23d, 24th and 25th of June, 1903. Sec- 
onded and carried. 

Dr. W. J. Chandler: I move that two more members 
be added to the Committee on Legislation. Carried. 
Drs. A. K. Baldwin and W. C. Parry, Hainesport, were 
added. 

The Secretary announced that he had been requested 
to offer the following amendment to the by-laws, pro- 
posed by Dr. C. Wigg : " Strike out the first sentence in 
Sec. 12, Chap. IL of the By-laws and substitute the fol- 
lowing: * The Committee on Nominations shall consist 
of one or more delegates chosen from each District So- 
ciety by its delegation, in the proportion of one delegate 
for every twenty-five or major fraction thereof of its 
membership.* " 



MINUTES. 73 

Dr. Godfrey: I move a vote of thanks be extended to 
our distinguished President, Dr. McGill, for his kind, 
impartial and parliamentary way of presiding over our 
deliberations, and that we also extend to him our best 
wishes for his success in the future. The motion was put 
by Dr. Godfrey and carried unanimously. 

Dr. McGill : I appreciate very much the courtesy and 
consideration with which you have treated me as your 
presiding officer. I have always considered, from the 
very inception of my medical career, that to be the Presi- 
dent of the old State Society of New Jersey was a very 
high medical honor, and it has been a source of great 
congratulation to me that I have successfully engineered 
the Society through its one hundred and thirty-sixth 
annual meeting. I am also pleased with the continuous 
success of this Society. Its organization differs from 
that of a great many other State societies in the fact 
that there is a very strong social element, an element of 
much importance to the medical profession. We as- 
semble here together and we get to know each other 
and become personally friendly. This cements the pro- 
fession together, a matter of vast importance, for, if we 
can stand back to back we are absolutely invincible. 
Under these conditions we can force legislation, for 
what more powerful man is there in the community than 
the country doctor, the family physician? Gentlemen, I 
thank you very much. 

On motion, the Society adjourned at 10:30 A. M. 
sine die. 



APPENDIX TO THE MINUTES. 



/ 



Treasurer's Report. 

Dr. Archibald Mercer, Treasurer, in account with the|Medical 
Society of New Jersey. 

Dr. ' 

June, 28, 1 901. Somerset Co., Additional 

Payment $2 00 

June, 1902. Atlantic Co., Assessment 42 00 

Bergen Co., " 36 00 

Burlington Co., " 30 00 

Camden Co., " 63 00 

Cape May Co , " 2 1 00 

" Cumberland Co., " 37 co 

Essex Co., •' 228 00 

Gloucester Co., " 30 00 

Hudson Co., ** 13700 

Hunterdon Co., " 1900 

Mercer Co., " 62 00 

Middlesex Co., •* 30 00 

Monmouth Co., " 44 00 

Morris Co., " 50 co 

Passaic Co , " 77 00 

Salem Co., '• 15 00 

Somerset Co., '* 27 00 

Sussex Co , " 21 CO 

Union Co , " 62 00 

Warren Co., " 21 00 

" Interest on U. S. Bonds 102 00 

$1,156 00 

To Cash balance in bank, June, 1901 2,467 86 

" U. S. Register Bonds 2.550 00 

$6,173 86 



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76 MEDICAL SOCIETY OF NEW JERSEY. 

Cr, 
June, 1901. Dr. E. W. Hedges, Cor. Secretary, 
Dr. W. J. Chandler, Rec. Secretary, 
Dr. H. W. Elmer, Chair, Stand- 
ing Committee 

Dr. Archibald Mercer, Treasurer, 

Orange Chronicle Co 

July, 1 90 1. Dr. O. C. Ludlow, Stenographer... 
Sept., 190T. L. J. Hardham, on acct.. Trans- 
actions. 

Nov., 1 901. L.J. Hardham, bal. Transactions, 
May., 1902. Printing, Dr. W. J. Chandler 



(( 



<< 



<< 



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By Cash balance in bank, June 21, 1902 
*' U. S. Registered Bonds . . 



'O' 



$10 00 




31 81 




27 30 




12 02 




28 00 




65 00 




300 GO 




570 70 




26 GO 






$1,070 83 




2.553 03 




2.550 00 



.173 86 



Report of the Corresponding Secretary. 

To the Medical Society of New Jersey : 

Your Corresponding Secretary respectfully reports that during the 
past year copies of our Transactions have been sent to all the State 
Societies and to many of the National Societies, also to a number of 
College Libraries and Medical Associations. 

We have received Transactions from the State Societies of Indiana, 
Iowa, New York, Colorado, California, Washington, Rhode Island, 
Nebraska, Wisconsin, Ohio, Connecticut, Massachusetts and Wyom- 
ing ; from the College of Physicians, Philadelphia, and from the Miss- 
issippi Valley Medical Association, all of which have been sent to the 
depository at Trenton in the care of the State Librarian. 

The County Societies of Cape May, Cumberland, Essex, 
Gloucester and Hudson were notified that under Dr. Taylor's reso- 
lution they were each entitled to appoint a representative to read a 
paper at this meeting. All but Cape May availed themselves of this 
privilege. 

Various inquiries from other State Societies and medical bodies 
have been answered, but the official life of your Corresponding Sec- 
retary has been by no means a strenuous one. 

Respectfully submitted, 

Ellis W. Hedges, Cor. Secy. 



report of the recording secretary. ^^ 
Report of the Recording Secretary. 

To the Medical Society of New Jersey : 

The year now closing has been one of decided progress for this 
Society. While its gain in membership has not been quite as great 
as that of its immediate predecessor, it has nevertheless been marked, 
and is much greater than that of any of the other years of our past. 

At the close of last session we had on the roll of Permanent Dele- 
gates ii6 names. Death has removed three— John Stiger, of Mend- 
ham, Morris Co., Calvin Terriberry, of Paterson, Passaic Co., and 
George Bayles, of Orange, Essex Co. At our last meeting five names 
were dropped from the roll. To fill the vacancies thus created the 
following nominees have been selected : From Morris Co., B. D. 
Evans, of Morris Plains ; from Passaic Co., Andrew F. McBride, of 
Paterson; from Essex Co., Aaron K. Baldwin, of Newark; from 
Hunterdon Co., George N. Best, of Rosemont ; from Monmouth Co., 
Cyrus Knect, of Matawan ; from Cumberland Co., Joseph Tomlinson, 
of Bridgeton ; from Cape May Co., Randolph Marshall, of Cape May, 
Wm. A. Lake, of Green Creek ; from Somerset Co., Mary E. Gaston, 
of Somerville ; from Union Co., no nominee as yet selected. There 
were also laid over from last year the names of H. B. Costill, of Tren- 
ton, Mercer Co., and J. M. Reese, of Phillipsburg, Warren Co. Next 
year being the regular time set apart for the election of Permanent 
Delegates, each county will be entitled to select one or more Perma- 
nent Delegates, according to its membership. 

The records of the Registration Book show that eighty Permanent 
Delegates were present at the last annual meeting, and thirty-six were 
absent. The following have been absent from two consecutive annual 
meetings : From Camden Co., James M. Ridge, of Camden, and 
Alexander Marcy, of Riverton ; from Passaic Co., W. K. Newton, of 
Paterson ; from Salem, F. Bilderback, of Salem ; from Sussex Co., Sid- 
ney B. Straley, of Newton ; from Warren Co., William H. McGee, .of 
Belvidere. 

The Standing Committee have accepted the excuse of Dr. Alex- 
ander Marcy, of Riverton. The excuses of the others not being suffi- 
cient, their names are dropped from the roll of Permanent Delegates, 
and their respective County Societies, upon notification from the Sec- 
retary, are entitled to select nominees to fill the vacancies. 

Our actual gain in membership one year ago was8i. This year 



78 MEDICAL SOCIETY OF NEW. JERSEY. 

we have gained 'JT, The largest part of this gain was made in the 
counties of Hudson and Essex. Last year Hudson was the banner 
county. This year she has allowed Essex to win that distinction. 
Hudson gains 20 members, while Essex gains 24. It is almost inevi- 
table that these two populous counties should show the largest aggre- 
gate gains. But if we consider percentages, we find that very active 
work has been going on in several of the smaller counties. Essex's 
gain of 24 represents an increase of only 1 1 per cent., while Middle- 
sex shows a gain of 16 per cent., Somerset 17 per cent., and Hudson 
over 18 per cent. 

In looking over the different sections of the State we see many 
encouraging features, but we also recognize that there is much — very 
much — work yet to be done. There are many regular practitioners in 
this State who are not members of any of our county societies. There 
are also some, who are members of these county societies, but who 
(to their shame be it. said) allow the stigma of delinquency to rest 
upon their names, and thus the good repute of their society is impaired 
and they are themselves deprived of privileges which every medical 
man ought to consider it an honor to possess. In one county, the 
President and two Vice-Presidents are on the delinquent list. Of only 
one county in this State can it be said that it has no organization con- 
nected with the Medical Society of New Jersey. Yet in this very 
same county there are many physicians of influence, and some of a 
more than local reputation. It is to be hoped that another year will 
not pass ere they may be induced to organize a county society and 
send their regular delegation to the Medical Society of New Jersey. 

Many of the County Secretaries were mindful of the request made 
last year to send in their membership lists two weeks before the pre- 
scribed time, but some retained their lists until the ten-day limit of the 
by-laws had almost expired. 1 regret to say that from the secretaries 
of two of the county societies I have failed thus far to get any report 
whatsoever. This is unfortunate and unjust to their district societies, 
for without these reports the mailing list for the distribution of the pro- 
grammes is incomplete, and these counties themselves cannot be rep- 
resented in the roll of membership published annually in the Transac- 
tions. 

In some of the counties the lamp of progress burns dimly. There 
is but little interest in scientific progressive medicine ; and while the 
county organization is kept up, there is no real growth, and the active 



COMMITTEE ON BUSINESS. 79 

work falls on a chosen few. Eight counties report practically the 
same membership as that of last year, and several of these have made 
no essential change for many years. But we need not dwell upon 
these somewhat depressing, though suggestive facts. The remedy is 
obvious to every one. 

Last year the County Secretaries were requested to furnish a list of 
their delinquent members. Many have done so. Next year it is de- 
sirable to know also the number of regular physicians not members of 
the County Societies, and also the number of homeopathic, eclectic and 
irregular medical men throughout the State. If we are to organize 
for active and aggressive work, we must know what material we have 
on hand, what material we can recruit from, and what obstacles we 
have to overcome in our own profession. The reports of the various 
committees will show that we have not been idle during the past year. 
The establishment of a Sanatorium for the treatment of Tuberculosis 
is assured as one of the results of our labors. But this is only the 
beginning of that work which we, as physicians, must institute and 
carry on. In order to do this we must have influence with our legis- 
lators. And to have influence with them we must be able to sho>y 
that we are not a hap-hazard handful of'visionary schemers, but that 
we represent the united medical profession of New Jersey — that we 
control and speak directly for over 1,000 voters, and indirectly influ- 
ence the suffrage of tens of thousand of others dwelling in various 
municipalities throughout the whole State. We shall then find that 
when we go before our legislative bodies we are addressing a most 
attentive and tractable body of public servants. 

Let us, then, devote ourselves to the perfecting of organization in 
the medical profession. Let us build up our county societies, quench 
petty jealousies, allay internal dissensions, and as a strong, united 
society labor faithfully for the accomplishment of those noble 
purposes which are ever the chief object and aim of our most honor- 
able calling. 

\Vm. J. Chandler, Rec. Secy. 



Report of the Committee on Business. 

Mr, President and Gentlemen of the Medical Society of New Jersey: 
The Committee on Business present the printed programme for 
order of exercises of 'this, the one hundred and thirty-sixth annual 
meeting of the Society. 



8o MEDICAL SOCIETY OF NEW JERSEY. 

Your committee have omitted the Wednesday Evening Literary 
Session, in order that time might be provided for social enjoyment at 
the reception to be given under the auspices of the Committee of 
Arrangements. 

The appointment of essayists from five successive counties in each 
year pursuant to the resolution passed two years ago has been satis- 
factory, in fact, four of the counties only having responded with 
papers as follows : 

Joseph Tomlinson, Bridgeton, '* The present methods of education 
from the standpoint of the physican ; " Edward J. Ill, Newark, " The 
cause and treatment of sterility in women ;" George E. McLaughlin, 
Jersey City. " The pathology of appendicitis " Jrom a histological 
research of fifty cases, lantern illustrations ; George E. Reading, 
Gloucester, report of a case of tumor of the orbit. The committee 
hope that in future years all of the essayists appointed will respond, 
as the papers thus far presented under this head have been of ma- 
terial advantage and added much to the scientific interest of the 
meetings. 

The Business Committee would again recommend that the time 
limit of fifteen minutes as adopted by resolution of the Society, for 
all papers, be rigorously enforced and also that the time allowed 
for the discussion of papers or for the ordinary business questions 
incident to the progress of the meeting, shall not be exceeded. Your 
committee are sorry to report the non-observance of this rule by the 
members. 

Preseniation of pathological specimens, new instruments and ap- 
paratus. —In the whole State there are a large number of hospitals in 
which many interesting pathological specimens are obtained annually. 
The difficulty of transportation would seem to deter the members 
from presenting at the meetings these specimens which would add so 
much to the scientific interest of the sessions. It is particularly re- 
quested that at future meetings efforts may be made in this direction 
under the heading " reading of such papers as may be approved by the 
Business Committee." The following are presented : " Suppuration 
of the kidney," by Ramon Guiteras, New York ; *' The septicaemia 
clause of accident insurance policies," Daniel Strock, Camden. 

The committee are anxious that a feature of this meeting shall be 
the discussion upon the question proposed, *' What are the best 
methods to prevent the spread of Tuberculosis." At the present 



REPORT OF COMMITTEE OF ARRANGEMENTS. 8l 

time this is a question of especial importance in this State. Under the 
State Tuberculosis Commission, an inquiry is now being made for the 
purpose of ascertaining the number of cases at present under treat- 
ment and a general discussion of this subject is desirable and im- 
portant. 

The question proposed by the Business Committee for next ) ear's 
discussion is, •* Vaccination." How long does it protect ? How shall 
it be controlled } What are the sanitary and commercial aspects.^ 

The Business Committee take this opportunity of thanking the 
members who have so kindly consented to present papers at this 
meeting and wish to impress upon the Society the importance of the 
general scientific work and particularly request at future meetings a 
more liberal response in the presentation of voluntary contributions, 
reports of interesting cases, preparation of pathological specimens or 
exhibition of new instruments or apparatus, in order that the 
program may more fully meet the scientific requirements of the 
Medical Society of New Jersey. 

Respectfully submitted. 

Walter B. Johnson, Chairman, 

B. C. Pennington. 

Alexander McAllister. 

e. hollingshead. 



Report of the Committee of Arrangements. 

To the Medical Society of New Jersey : 

The regular profession of Atlantic City and Atlantic County wel- 
comes the Medical Society of New Jersey to this, their fifth session in 
this city and its one hundred and thirty-sixth annual meeting. We 
deem it an honor and a privilege to be associated with this body, 
founded in the days of our great-grandfathers and which has main- 
tained such a dignified and ethical standing. 

Your Committee of Arrangements chose the new Rudolph Hotel as 
the place of meeting, and throOgh the courtesy of the management of 
the hotel, places at your disposal for your meeting and pleasure this 
large convention hall and the conveniences of the house. A general 
rate of three dollars per day has been arranged for this meetinjg, and 
any desiring to remain over wilt be accommodated at the same fate. 

You will find twenty-six exhibitors, representing the best houses 



82 MEDICAL SOCIETY OF NEW JERSEY. 

only, who have placed their books, medicines, foods and appliances on 
exhibition in the live rooms on the floor adjacent to this hall. You 
will find everything there that could be desired, and it is requested 
that you will visit all of them long and often. 

No entertainment or amusement has been planned that will inter- 
fere in any way with the business sessions. On Wednesday evening, 
at 8:30 P. M., in this room, a reception will be given to all delegates, 
exhibitors, friends and ladies, to meet the officers of this Society and 
become better acquainted. This will be followed by music and danc- 
ing. To those who may not have the pleasure of their accompanying 
ladies, or wishing to steal away for a little time, we invite you to a 
corn-cob pipe and light refreshment at the smoker in the Grotto of 
this hotel at 10 o'clock the same evening. 

You who have known the Atlantic City of the past will now find 
yourselves in a new city — a city of over 30,000 permanent inhabitants. 
Our surrounding meadow land on the island has been almost entirely 
reclaimed and filled to g^ade, thus rendering the city more sanitary 
than ever and almost entirely exterminating the pest of every New 
Jersey resort — the mosquito. The unfortunate conflagration of last 
spring will not diminish the popularity of this resort, but will bring in 
its wake a new class of strictly modern hotels that will appeal stronger 
to the traveling public than ever before. 

It is a coincidence worthy of note, tnat upon the same day England 
expects to crown her future ruler, this Society will elect its new Presi- 
dent for the coming year. May our new President be as successful 
as his worthy predecessors. 

Gentlemen, we again bid you welcome to Atlantic City and trust 
that your visit here may be both profitable and enjoyable. 

W. Blair Stewart. 
Chairman Committee of Arrangements. 



Report of Committee on Honorary Membership. 

Camden, N. J., June 24, 1902. 
To the Medical Society of New Jersey : 

The Committee on Honorary Membership would respectfully report 
that the name of J. Leonard Corning, A. M., M. D., LL.D,, was pro- 
posed at the last annual meeting of the Society for Honorary Mem- 
bership and referred to this Commitee. 



COMMITTEE ON HONORARY MEMBERSHIP. 83 

Dr. Corning was born in Stamford, Conn., and received his medical 
education at Heidelberg, Germany, graduating in the year 1878, at 
the University of Wtlrzburg, Germany, and receiving the Degree of 
Doctor of Medicine, Surgery and Obstetrics. His subsequent hospital 
experience was gained in the leading institutions of Europe and 
America. On his return to this country he established himself in 
New York City, and was for two years assistant to the late Dr. J. 
Marion Sims. His chief specialty, however, was diseases of the ner-> 
vous system, to which he devoted himself assiduously and gained a 
large and lucrative consulting practice. 

Dr. Corning has contributed numerous and valuable papers to 
medical literature, which have been published in the medical journals. 
The following are some of his recent publications : 

•'Prolonged Instrumental Compression of the Primitive Carotid 
Artery as a Therapeutical Agent." 

" Carotid Compression (a Monograph)." 

" Brain Rest ; a Disquisition on the Curative Properties of Pro- 
longed Sleep." 

•• rhe Nature of Nervousness." 

" Cerebral Exhaustion." 

•• Can Insanity be Philosophically Defined ?" 

•* Consideration on the Pathology and Therapeutics of Epilepsy. " 

*' Electrization of the Sympathetic and Pneumogastric Nerves, with 
Simultaneous Bilateral Compression of the Carotids." 

•* On the Prolongation of the Anaesthetic Effect of the Hydrochlor- 
ate of Cocaine when Subcutaneously Injected; an Experimental 
Study." 

•• Spinal Anaesthesia." 

" Prolonged Local Anaesthetization by Incarceration of the Anaes- 
thetic Fluid in the Field of Operation." 

" Local Anaesthesia in General Medicine and Surgery, being the 
Practical Application of the Author's Recent Discoveries." 

These three last mentioned publications are devoted exclusively 
to Dr. Coming's researches in the domain of local anaesthesia. 

The claim of original discovery in his paper on " Spinal Anaesthesia 
of the Cord " was acknowledged and quoted in the Paris Medico- 
Chirurgical Journal, 1901, as well as in the New York Medical 
Record, 1900. 

Dr. Corning is consultant in nervous diseases to several hospitals 
and other charitable institutions. 



84 . MEDICAL SOCIETV OF NEW JERSEY. 

In consideration of Dr. Coming's medical record, and as a writer of 
merit and distinction, your committee would recommend his election 
as an Honorary Member of the Society. 

H. Genet Taylor. 

Charles J. Kipp. 

Alex. W. Rogers. 



Report of Delegates to the American Medical 

Association. 

CHARLES J. KIPP. 

Of the delegates to the American Medical Association elected at 
our last meeting, Drs. Halsey and Kipp attended the meeting. Dr. 
Marsh was unavoidably kept away, and his place was filled by his 
alternate, Dr. Marvel. We attended diligently all the meetings of 
the House of Delegates. New Jersey was represented on two com- 
mittees. Dr. Marvel was elected a member of the Judicial Council 
for a term of four years, and Dr. Kipp was appointed a Delegate to 
the International Medical Congress, to be held at Madrid, Spain, in 
the spring of next year. A vast deal of important business was trans- 
acted relating to national legislation, the medical service of the army 
and navy, and the constitution and by-laws of the National Medical 
Association. The House of Delegates is very desirous that all State 
Medical Societies should reorganize so as to conform as much as 
practicable to the organization of the American Medical Association, 
and a committee has drawn up a constitution and by-laws which will 
be submitted to you by the Committee on Revision of the By-laws for 
your action. I may say here that I would recommend its adoption 
and that a competent lawyer be employed to advise us as to the 
changes necessary in our charter to enable us to reorganize in accord- 
ance with the laws of this State. I have consulted the Attorney Gen- 
eral about this matter, and have obtained from him an opinion that, 
under the laws of 1890, page 422. sections 2 and 5, we can do this 
without giving up the charter under which we are now working or 
applying to the legislature for an amendment to the charter. The 
constitution and by-laws proposed have already been adopted by 
several other National Medical Societies. 

The following resolution was adopted by the House of Delegates: 



NATIONAL LEGISLATION. 85 

''Resolved, That State associations or societies, in counting mem- 
bers for a basis of representation in this house shall count only 
members in good standing who pay regular dues to the State Socie- 
ties either directly or indirectly through county societies." 

Another resolution adopted is as follows : **Resolved, That the 
House of Delegates recommend the adoption by the County Medical 
Associations in affiliation with this body the following resolution : 
" Resolved, That any member of this County Medical Society proven 
guilty of the division of fees, either the giving or taking of a part of a 
fee without the full knowledge of the patient, be held guilty of miscon- 
duct for which he may be expelled from the County Medical Society.'* 

This resolution was also adopted : '* Resolved, That it is the sense 
of the House of Delegates of the American Medical ^ Association that 
the solicitation of votes for office is not in keeping with the dignity of 
the medical profession, nor in harmony with the spirit of this Associa- 
tion, and that such solicitation shall be considered a disqualification 
for election to any office in the gift of the American Medical Associa- 
tion." 

The President of the Association, Dr. Wyeth, recommended that 
each State Medical Society send at least one delegate to the Inter- 
national Medical Congress at Madrid. 

In conclusion, I will quote the final paragraph of the President's 
address : 

•• To labor for the alleviation of suffering and for the restoration 6i 
health is a noble avocation, but to teach our fellows how to avoid 
disaster is a prouder privilege and a higher duty. We should be 
leaders of men. How better can we protect the people from disease 
in all its various forms and insidious processes than by perfecting 
in every county and in every community an organization which shall 
be ever watchful and insistent upon obedience to the laws relating to 
the public health. 

Report of Delegate to the Conference of this 
Committee on National Legislation. 

To the Medical Society of New Jersey : 

Gentlemen :— Your delegate to the Conference of the Committee 
on National Legislation would report that he attended the conference, 
which was held at the Arlington Hotel, Washington, D. C, on April 
loth and nth. There were- twenty-four delegates present at the 
conference. 



86 MEDICAL SOCIETY OF NEW JERSEY. 

The conference acted upon some important matters, such as 
changing the name and increasing the powers of the Marine Hospital 
Service, which it endorsed ; the anti-vivisection bill, which it con- 
demned ; the bill to increase the regular medical staff of the army and 
to retire Surgeon-General Sternberg with the rank of Major-General, 
both of which the conference endorsed. It was the unanimous opin- 
ion of the conference that the new committee appointed by the 
American Medical Association would not so well cover the ground 
hitherto occupied by the Committee on National Legislation, and that 
the present committee should be continued. 

A full report of the meeting can be found on page 1023 of The 
Journal of the American Medical Association for April 19th, 1902, 
and also in the proceedings of the June meeting of the Association. 

Respectfully submitted, 

George Evans Reading. 

Delegate. 



Report of the Committee on Sanatorium. 

June 24. 1902. 
To the Medical Society of New Jersey : 

Your Committee on Sanatorium for Tuberculous Diseases beg leave 
to report as follows : 

Profiting by our experience of the previous year, we began our 
campaign at a much earlier date. Through Dr. Newton, a hearing 
before Governor- elect Murphy was arranged for. As a result of this, 
the Governor, in his inaugural address, strongly urged the necessity of 
such a sanatorium. 

This gave us an excellent foundation to work upon, and we took 
immediate advantage of it. A meeting was called and the bill of the 
previous year was adopted. The Chairman and Secretary were ap- 
pointed a sub-committee to secure some influential member to intro- 
duce the bill in the Legislature. Through the aid of Dr. Fithian, of 
Camden, Mr. John G. Horner, Republican leader of the House, was 
enlisted in favor of the bill and agreed to introduce it. On looking 
over the old bill several objections were discovered, and the committee, 
on the advice of Mr. Horner, employed Ex-Judge Lanning, of Trenton, 
to draft a proper bill. This was introduced by Mr. Horner, and 



COMMITTEE ON SANATORIUM. 87 

passed the House by a large majority after a public hearing had been 
had upon it before the committee having the bill in its charge. 

The bill then went to the Senate, where it was hung up for some 
time, and as the end of the session was drawing near, a meeting of 
the committee was called to urge its passage. Through Dr. Jones, of 
Camden, an interview was secured with the President of the Senate, 
Mr. Francis, who promised to push the bill along as fast as possible. 
This he did, and the bill passed by a large majority. 

The next thing was to secure an appropriation to put the bill into 
effect. A meeting of your committee was called to urge the Joint 
Committee on Appropriations to insert an item for the Sanatorium in 
the regular appropriation bill. This we were unable to accomplish, 
owing to the opposition of Senator Hutchison, of Mercer, the chair- 
man of the Joint Committee. 

This was the situation on the last day of the session, and it looked 
as if all the committee's work would be for naught, as nothing could 
be done without an appropriation to begin operations upon ; but Mr. 
Horner had a consultation with the Governor, and, by exerting the 
great influence possessed by them, a supplement to the appropriation 
was passed by both houses, at the last minute, giving fifty thousand 
dollars to the Board of Managers of the Sanatorium. 

The Governor appointed the following gentlemen as the " Board of 
Managers : " Drs. Charles J. Kipp. Newark ; William S. Jones, Cam- 
den ; O. H. Sproul, Flemington ; James S. Green, £lizal>eth ; Austin 
Scott, New Brunswick ; Elmer Barwis, Trenton ; Colonel E. A. 
Stevens. Hoboken, and Frank L. Sheppard, Elberon. 

The board met on April 30th, and organized by electing the follow- 
ing officers: President, Dr. Charles J. Kipp; Vice-President, Dr. 
Austin Scott ; Secretary, Dr. James S. Green ; Treasurer, Colonel 
E. A. Stevens. 

The following Committee on Site was appointed : Dr. O. H. Sproul. 
Colonel £. A. Stevens and Dr. Elmer Barwis. They have as yet 
agreed upon no site for the sanatorium. 

In conclusion, the committee would suggest that, in recognition of 
the vital assistance rendered to us, the Medical Society of New Jersey 
offer a vote of thanks to Governor Murphy and Mr. Horner. 

Respectfully submitted for the committee, 

George Evans Reading, 

Secretary. 



88 medical society of new jersey. 

Report of Dr. Kipp, President of the Board of 
Managers of the Sanatorium. 

You have heard that the Legislature appropriated $50,000 for the 
purchase of a site and the erection of suitable buildings for the care 
of indigent consumptives. We have reason to believe that there are 
at least 500 indigent consumptives in this State. 200 is the largest 
number now taken care of in any one institution, and it is the opinion 
of the persons in charge of such institution that it is not advisable 
for many reasons to increase this number in any one institution, but 
rather to build more. 

The cost of the sanatorium for consumptives at Rutland, Mass., 
built by the State of Massachusetts, was three hundred thousand 
dollars for building and equipment and the institution cannot ac- 
commodate quite 250. More than 400 patients were refused admis- 
sion in one year for want of room. 

The cost of maintenance of each patient in such institution is some- 
what over $8 a week, or about $450 a year ; and our institution for 
200 patients would, therefore, require an annual appropriation of 
I90.000, and if the State wants to take care of the whole number in 
this State, $200,000 a year would be required for maintenance. 

To the average legislator this sum will doubtless appear enormous, 
and I question that he will consent to give this amount unless you as a 
Society and the members individually will take the pains to see these 
men and explain to them that unless the State is willing to spend 
this amount it would be better to give up the institution altogether, as 
it could not be maintained for less in a manner creditable to our 
State. I can assure you that the commission has no desire to spend 
more money than is absolutely necessary to provide suitable accom- 
modations for these patients — accommodations that will give them the 
best possible chance to arrest or cure the diseases from which they 
are suffering, and not spend the State's money for mere orna- 
mentation. 

The commission cannot and does not ask you to endorse in advance 
what they may wish to do, but if you as a Society couW see your way 
clear to express your confidence in the judgment and fidelity of the 
members of the cominission and ask the Legislature to appropriate 
for the work entrusted to them such sums, as in their opinion is 
necessary to carry out their plans, you would no doubt greatly aid 



COMMITTEE ON BOVINE TUBERCULOSIS. 89 

the commission in getting the necessary appropriation. This Society 
initiated the movement for the establishment of sanatoriums for con- 
sumptives by the State, and if you have confidence in the men ap- 
pomted by the Governor, and do not want the project to fail, I hope 
that you will give us every help, either as a Society or as individuals, 
to make this or these institutions a credit to the State, by using your 
influence to get suflicient support from the State Treasury. 



Report of Committee on Bovine Tuberculosis. 

The attention of the State Medical Society is drawn to the short- 
comings of dairymen concerning measures for the prevention of 
tuberculosis among their cattle. Our inspections show that few 
farmers make any provision for ventilation of cow stables, and that 
animals are generally kept under conditions which are recognized by 
sanitarians as favorable to the dissemination of tuberculosis. Until 
owners of cows which are kept for the production of milk shall 
conduct the business of dairying in an enlightened manner, and until 
they can show that they are doing their utmost to prevent the intro- 
duction of tuberculosis into their herds, and to prevent the spread of 
this affection among their cattle, payment for animals found to be 
infected with tuberculosis is like pouring money into a rat hole. It is 
an effort to cure trouble which could be averted by the owners of 
the animals if they would apply the ordinary and proper measures for 
the introduction of air and sunlight into the stabled of the animals, for 
keeping the bodies of the animals clean and for the cleanly collection 
and distribution of the milk. It is certainly impolitic for ihe State to 
provide a large appropriation for the reimbursement of owners of 
cattle when these owners could, by the enforcement of reasonable and 
proper means for preventing the infection of their herds, escape all 
losses, or nearly all losses, from b6vine tuberculosis, and thus render 
an appropriation necessary only for the inspection and supervision of 
dairy premises. 

The very energetic discussion which has prevailed throughout the 
civilized world during the last twelve months, concerning the views of 
Koch with reference to the transmission of bovine tuberculosis to 
human beings, is still unabated and the question is by no means 



90 MEDICAL SOCIETY OF NEW JERSEY. 

settled, but the views expressed by Koch and his adherents cannot be 
said to have thus far been established by sufficient proof to warrant 
their acceptance. 

Charles Young. 
Henry Mitchell. 



Report of the Committee on Abuse of 

Medical Charity. 

Mr. President and Members : 

Your committee has received the following communication from 
the attending staff of Cooper Hospital, in Camden, and the managers 
of the Camden City Dispensary, viz : 

At the last annual meeting of the Essex District Medical Society, a 
report was received from a committee appointed the previous year, 
the object of which was to determine, if possible, the extent of the 
abuse of medical charity in Essex County. That report was very 
complete, including, as it did, the result of the year's work in every 
medical institution. It showed that in a very few clinics all patients 
were admitted without inquiry, one or two only admitted applicants 
who brought a note signed by a responsible person, stating that they 
were needy and deserving. The larger proportion of the institutions 
were in the habit of questioning those who applied for treatment, 
refusing aid to all who seemed to be undeserving of charity. One 
institution, the Newark Charitable Eye and Ear Infirmary, had, during 
the year, made systematic efforts to exclude unworthy ones by the 
employment of a woman whose duty it was to personally question 
each applicant, and in case there was a doubt in her mind to make 
further inquiry of his or her home conditions. This plan appears to 
have been, in a great measure successful, for out of more than five 
thousand applicants, over nine hundred were excluded by this means 
alone, an abuse of medical charity fifteen per cent, the proportion of 
about one in every six, and when it is remembered that there is a 
class of impostors who will stoop to any means of deception it seems 
to be fair to assume that at least one in every five, who knocks at the 
doors of our clinics for aid, is undeserving. Personal investigation as 
made in this institution and the Camden ones, demonstrates the pos- 
sibilities of such efforts. 

Many of our larger medical charities are so deeply under obli- 
gations for support to persons and corporations that it is a difficult 



REPORT OF COMMITTEE ON MILK. 9I 

thing for them to adopt hard and fast rules in the conduct of their 
clinical work. Your committee still believes that legislation would 
be the surest and quickest cure for this abuse, but there stands in the 
way the difficulty of obtaining legislative action, as there is a decided 
difference of opinion existing in the minds of members of this Society 
as to the feasibility of such action. We ask to be excused from pre- 
senting the form of any legislative bill at this time. There is no ques- 
tion as to the importance of this subject, not only as it pertains to the 
younger members of our profession, but to the public at large. But 
your committee is at a standstill in a measure on account of the obsta- 
cles of legislation and the probable lack of harmony of action by the 
various institutions of the State. There appears to be the possibility 
of some action among physicians themselves, as, for instance, the 
adoption in this Society of a resolution which will deter any of its 
members from accepting a position upon the staff of any hospital, 
dispensary or clinic which has not adopted a systematic and efficient 
plan for the exclusion of all unworthy applicants for medical charity. 
Your committee favors some such action. 

Respectfully submitted, 

T. Y. SUTPHEN. 

G. H. Balleray. 
J. S. Baer. 



Report of Committee on Mix-k as a Food and as a 

Means of Contagion. 

DRAWN UP BY RICHARD COLE NEWTON, M.D., CHAIRMAN. 

It is a satisfaction to be able to report that a great deal of work 
has been done on the important subject of milk since the last meeting 
of the State Society. Probably the most comprehensive and valuable 
investigation on this subject ever undertaken was instituted last sum- 
mer by the Rockefeller Institute for Medical Research in conjunction 
with the New York City Board of Health. The report of this work 
will not be made public until after another summer's work. It will 
appear as a communication to the Rockefeller Institute, and can 
scarcely fail to be of great interest and value. The announcement of 
Professor Robert Koch before the British Congress on Tuberculosis 
last July, that human and bovine tuberculosis are not identical, and 



92 MEDICAL SOCIETY OF NEW JERSEY. 

that the latter is not communicable to man, has a direct bearing upon 
the milk question. This declaration has stirred the medical world as 
perhaps none other has ever done, unless it may have been the pro- 
mulgation of Professor Koch's alleged discovery of a cure for human 
tuberculosis some half score of years ago. The great interest, not to 
mention the acrimony which the Professor's statement has called out, 
have led to numerous experiments undertaken to verify or confute his 
claims. Some of these experiments have been made public, and an 
impartial view of the field compels your committee to assert that the 
question is still subjudice, although unquestionably the air has been 
cleared up somewhat and we are nearer to a knowledge of the 
truth than we were a year ago. Unfortunately, it is a problem quite 
difficult of solution, owing to the impracticability of direct inoculation 
of human subjects with bovine tubercle bacilli ; however, a number of 
the best observers, including Smith, of Boston, who, in fact, several 
years before Professor Koch's theatrical announcement, called attention 
to the differeilces between bovine and human tubercle bacilli, as re- 
gards morphology, life history and virulence.^ Chapin and Park, of 
New York, Repp, Bang, Stockman and others, think that the danger 
of the transmission of tuberculosis from cattle to man by milk has been 
overestunated ; while a number of others, including Salmon, of Wash- 
ington, Coit, of Newark, Emmert, of Iowa, Law, of Cornell Uuiversity, 
Williams, of the Brompton Hospital, England, Tscherming, of Copen- 
hagen, Pfeiffer, of Weimer, and Cozette, of Nay on, France, report 
cases of direct infection of human beings from cattle. It will be seen, 
therefore, that the weight of authority is strongly against Professor 
Koch's position at the present time, and all are agreed that no effort 
should be spared to eradicate entirely bovine tuberculosis ; and under 
no circumstances should the milk of tuberculous cattle be used as 
food by human beings. 

As to the nourishment and care of milch cattle, Creighton says': 
'* I cannot escape from the conviction that the peculiar errors of 
nutrition in the domesticated bovine species all over the world are the 
real fountain and source of human tubercle." This opens of itself a 
wide field for discussion, upon which your committee has entered in 
former reports, but will not go into further at this time. 

■ During the year some interesting and valuable papers have appeared 
on modifications of milk for infant feeding. Among the authors we 
note Winters, Chapin, Kerley, of New York, White and Macdonald, 



REPORT OF COMMITTEE ON MILK. 93 

of Boston, Openheimer and Frcidjung abroad, and so on. Unques- 
tionably the modification of cow's milk by cereals is becoming a more 
common practice, and such milk seems to answer the purpose better 
on an average than milk modified without the addition of cereal 
gruels. Progress is ^till being made in this important direction. 
However, it can be safely asserted that a more liberal and diversified 
diet is allowed infants than formerly, and that rickets and scurvy are 
presumably less common in bottle-fed children in consequence. 

The testimony against sterilization and pasteurization becomes 
stronger. Blackader, Winters, Dukes. Poore, Smith snd Atkinson, 
all condemn these processes as destroying some of the valued nutri- 
tive qualities of milk. Some of them insist upon feeding the milk as 
soon as possible after milking. Of the reports of some elaborate 
experiments and the conclusions drawn from them, we have not the 
time to speak ; but. on the whole, the outlook is encouraging, both 
from the amount and character of the work done and the fact that the 
public has been largely educated in the matter of milk, and is disposed, 
so we believe, to stand firmly behind the medical profession in its 
effort to improve the quality of this essential article of diet. 

The increased interest which the public take in the proper produc- 
tion and handling of milk is well shown by the fact that the daily 
papers are willing to devote considerable space to this and similar 
questions. In the Newark Evening News of June 6th, 1902, is an 
editorial under the title of " A Beneficent Charity," which recites the 
great good which Mr. Nathan Strauss has accomplished by his pure 
milk depots in New York City, and especially by his pasteurizing 
plants in the foundling hospitals on Randall's Island, where the mor- 
tality amongst the inmates has decreased from 51 per cent, to 18 per 
cent, since the plant was introduced. I might say in passing, that it is 
probably not generally known that our Dr. Coit put the idea of this 
fine philanthropic enterprise into Mr. Strauss's head by his efforts to 
get the New Jersey State Society to take up the work of purifying 
milk, and the perusal of an account of these proceedings led Mr. 
Strauss to send to Dr. Coit for practical hints as to how he could pro- 
vide cheap, pure milk for the poor of New York City. Mr. Strauss 
ultimately carried out many of Dr. Coit's suggestions. 

Furthermore, I might add that the attitude of the editor of the 
Newark Evening News toward scientific medicine and the bettering 
of the condition of the poor, as evinced in his paper's vigorous and 



94 MEDICAL SOCIETY OF NEW JERSEY. 

judicious support of the efforts of this Society to get the law estab- 
lishing a State sanatorium for consumptives passed, and in other 
ways, reflects credit upon the paper and upon the intelligence of its 
readers, and in our opinion deserves the recognition and commenda- 
tion of this Society. 

It is the education of the public which is necessary, before any 
satisfactory sanitary reforms can be carried out, and the daily papers 
are unquestionably the surest means of reaching and persuading the 
average man. It is, therefore, with especial satisfaction that we note 
the intelligent and public-spirited course of this particular paper. 

In the editorial referring to Mr. Strauss's work, to which allusion 
has already been made, the following lines occur : •* There is a lesson 
in this charity of too much practical importance to be overlooked by 
any city, and one that Newark would do well to heed at the present 
juncture." * * * " It is possible that we have no philanthropist 
among us to work along lines similar to those adopted by Nathan 
Strauss, but in a very large sense his work may be done here by a 
careful enforcement of the ordinances designed to secure purity in 
the milk supply of the city. This is imperatively demanded in the 
interests of the public health, and at no time so earnestly as during 
the hot months of the summer." 

It is not customary to quote so freely from the secular press in a 
purely scientific report, but we have done so partly to commend to 
your appreciative attention the sound sense and public spirit displayed 
in the editorial, and partly because it furnishes an excellent text for 
what your committee especially desires to impress upon your minds 
at this time as necessary to be done, and done promptly. The law 
seems to furnish the various health boards with sufficient authority to 
do what the Board of Health of the City of New York has done, and 
is now doing. (If, however, our laws are not sufficiently comprehen- 
sive, it is assuredly the province of this Society to get better laws 
passed). 

In undertaking the practical improvement of the milk supply, the 
Board of Health of New York City determined last year to work 
along three lines : 

(i) Examining the milk at different periods during its transporta- 
tion from the time of its arrival at the creamery to the time of its 
delivery to the consumer. ' 

(2) Studying the conditions of the far ins to learn (a) why an 



REPORT OF COMMITTEE ON MILK. 95 

excessive development of bacteria in the milk should take place, and 
ip) how this could be prevented. 

(3) Studying the health of children and infants receiving milk in 
different grades of purity. Part of this work has been carried out by 
the Rockefeller Institute for Medical Research. 

The examination of the milk in transit consists in taking its temper- 
ture quite regularly at (i) the creamery when it is delivered from the 
farm, (2) when it is put on the cars, (3) during its transit in the cars. 
(4) when delivered in the city to the dealer, and (5) when it is deliv- 
ered to the consumer. Besides this there are regular bacteriological 
and chemical examinations made of samples taken at unexpected 
intervals. If the temperature shall be found at any time over 55 deg. 
F., or if the bacteriological content at any time exceeds 1.000,000 per 
c. c. the producer and transporter are both warned that the milk is 
unfit for use, and will be emptied out and destroyed unless its condi- 
tion improves. At the same time an inspector is sent to the dairy to 
ascertain what the trouble is and why pure milk cannot be produced. 
The errors are carefully pointed out to the dairyman, and, generally 
speaking, the latter is anxious to correct them and to get his milk up 
to the standard. 

If the temperature of the milk when it reaches the creamery is too 
high, the farmer is informed that he must use more ice, and likewise if 
it is too high when it leaves the creamery, the creamery is instructed 
to be more particular about packing and cooling. Then the milk in 
transit on the railroads is examined, and again when taken off the cars, 
and the railroads are told that if they do not maintain a temperature 
below 55 deg. the milk will not be received, etc. And so again the 
city milk dealers receive the same instructions as the railroads. 

It appears that over five-sixths of all the milk brought into New 
York City comes through creameries, and that, as a rule, these are 
well conducted and the milk is properly handled and kept cool in 
these institutions. 

The Board of Health also insists that milk, when delivered to the 
consumer, shall not be over thirty-six hours old. Farmers are required 

to make two shipments a day to the railroads instead of one, as some 

« 

of them were in the habit of doing, so that some milk would be at 
least twelve hours old before it was put upon the cars, and in cJase it 
comes from a distance of three hundred and fifty miles, as much of 
it does, it is eighteen hours in transit, making it at least thirty-four 



96 MEDICAL SOCIETY OF NEW JERSEY. 

hours old before the consumer receives it, and in most cases several 
hours older. By a careful study of the bacterial contents of milk, it 
is found that average milk over forty-eight hours old is unfit for use 
and should not be sold. The taking of the temperature is a ready 
and fairly accurate method of determining the quality of the milk, as 
properly cooled clean milk will keep indefinitely. It was found, for 
instance, that the milk from the American dairies, at the Paris Expo- 
sition, was in better condition and more palatable than the milk fur- 
nished from the local dairies, although the former had come across 
the ocean and the latter was served on the day it was milked. 

In the matter of clean milk being furnished from ordinary small 
dairies, it is encouraging to read the report of the Milk Commission 
of the New York County Medical Association, in which it is pointed 
out that any small producer can furnish milk even up to the standard 
of certified milk by strict attention to detail, and that, too, without 
the use of an aerator, without a steam plant, and even without the 
intervention of a creamery, viz., if he will observe the three following 
conditions : (i) Strict cleanliness, (2) filtering the milk carefully, pref- 
erably through absorbent cotton, not wire netting, and (3) using plenty 
of ice, both to cool the milk and keep it cool during transportation. 
These statements being true, and the commission gave a number of 
instances to prove them, there is no question about the feasibility of 
requiring a much better average milk supply than any one in this 
State thinks of furnishing at this time except two or three of the very 
best dairies. 

The boards of health presumably have power enough to force the 
producers and dealers to deliver milk to consumers which shall be at 
least as pure and uncontaminated as that required to be furnished in 
New York City. 

Your committee, therefore, recommend that this Society issue a cir- 
cular, addressed to the boards of health throughout the State, urging 
them to adopt the simple and comprehensive rules of the New York 
City Board»of Health. In order to facilitate this action and make it 
apparent to the public why such measures are taken, we recommend 
that circulars of information similar to those issued by the New York 
City Board of Health be drawn up and printed in all the principal 
newspapers of the State, and that any other convenient means be 
taken to inform both the public and the milk producers and handlers 
of the necessity for greater care and cleanliness in the preparation 
and marketing of this invaluable article of food. 



REPORT OF COMMITTEE ON MILK. 97 

Milk commissions, which are more or less patterned after the Essex 
County Milk Commission (the creation of the fertile brain of our 
esteemed member, Dr. Coit) are springing up in various parts of the 
country, and cannot fail to do much good. The time has undoubtedly 
come in this State for the creation of other commissions in case the 
Essex County Commission does not care to undertake the certification 
of other dairies than the one already under their charge. 

It is held by some that one commission can only properly care for 
one dairy, and that each dairy should have its own commission. The 
New York County Association, however, are willing to certify the 
milk of any dairy selling milk in the boroughs of Manhattan or the 
Bronx, and already eight dairies are producing milk which their com- 
mission is willing to certify. 

To our minds the boards of health of each community should at 
least supervise the personnel and work of the commission, and should 
be satisfied that the work is fairly and intelligently done, otherwise 
this powerful influence for good is in danger of becoming an engine 
for evil. A circular recently issued by Mr. R. A. Pearson, M. S. Ass't 
Chief of the Dairy Division U. S. Department of Agriculture, urges 
that a milk commission of a " responsible body of citizens who are 
interested in an improved milk supply " be established in every town, 
and that they employ four experts, a bacteriologist, a veterinarian, a 
physician and a chemist, in the same manner as the Essex County 
Commission has done for years. Undoubtedly the county medical 
societies might take this matter up and appoint as many commis- 
sions as may be needed, making themselves responsible for the 
character and efficiency of the experts employed, etc. 

The milk of any dairy which complies with the requirements of the 
commission should receive the certificate of " certification " and be 
allowed to use the labels. Undoubtedly the most potent argument 
that can be advanced to induce the small farmers to endeavor to im- 
prove their herds and clean and regulate their plants until they can 
produce certified milk is the gain in money which will accrue. As 
pointed out by Dr. Chapin, in a paper in the Forum for May, 1902, 
the profit to the raiser of cheap milk after deducting the price of feed 
is less than one cent a quart in New York State at the present time, 
but the producer of clean milk realizes two or three cents a quart 
profit selling his milk on his own premises, and the certified milk 
dairies get from ten to fifteen cents a quart for their entire output, 



98 MEDICAL SOCIETY OF NEW JERSEY. 

while the demand for this product is constantly growing, and will 
grow indefinitely. 

Your committee, therefore, recommend that this Society rise to the 
situation and urge upon milk dealers, boards of health and county 
societies the carrying out of the suggestions of this paper, viz.: To 
recapitulate. That all boards of health insist that no dairyman shall 
be allowed to sell milk of which the bacteriological content shall be 
over 1,000,000 per c. c. ; nor of which the temperature shall be over 55 
deg. F. at any time from its production to its delivery ; nor milk from a 
dairy in which there may be a case of any disease amongst the cattle, or 
their milkers or attendants ; nor milk in which any preservative has 
been used ; nor milk over thirty-six hours old ; nor milk having any 
perceptible odor nor any color of dirt, or any coloring matter, or other 
ingredient, nor having an acidity of over two-tenths per cent., or a 
butter fat content of less than three per cent., nor total solids of less 
than twelve per cent. 

(2) That steps be taken "to apprise the public of the true facts 
about milk, to wit, that the great majority of the bacteria therein are 
entirely harmless ; that water is the least injurious ingredient in milk; 
that the temperature of the milk is the most easily obtained and gen- 
erally applicable test of its condition ; that milk is a culture medium 
par excellence, and therefore the greatest possible care must be exerted 
to prevent all forms of infection, but especially dirt. And that more 
milk commissions be appointed by the county societies, and that the 
societies shall be responsible for the character and work of these 
commissions, so that it shall be possible for any properly conducted 
dairy in this State to obtain certified milk labels and sell certified 
milk. That any needed modification of the existing laws be insisted 
upon, as, for instance, that skimmed milk be allowed to be sold as 
skimmed milk. 

Inasmuch as the credit for the institution of certified milk belongs 
to New Jersey, and its medical men, it would be bad in principle and 
a giving away of our fairly earned prestige if we allowed any other 
State to take precedence of us in following up the good work. It is 
our obvious duty to do all that we can do toward the enforcement of 
the present dairy laws, especially so that the poor man may obtain 
pure, wholesome milk, as well as his richer neighbor, who can afford 
to pay for certified milk. 



dr. stevens' relic. 99 

Correspondence Relating to an Old Parchment 
Containing a Petition to the Legisla- 
ture FOR A Charter for the Medical 
Society of New Jersey. 

New Brunswick, N. J., March 5, 1902. 
Wm. J. Chandler, M. D., 

Secretary Medical Society of New Jersey, 
Dear Doctor : — My wife, Mrs. Julia Dunham Stephens, when 
recently looking over some old family papers, found a petition to the Leg- 
islature of New Jersey, praying for a charter for the medical Society of 
New Jersey, signed in the handwriting of each of the following gen- 
tlemen: Dr. Moses Scott, Dr. Lewis Dunham, Dr. Jonathan Ford 
Morris, Dr. John G. Wall, who had been appointed a committee by 
the State Medical Society, Nov. 3d, 1789, *• to prepare and present a 
petition to the Honorable the Legislature now sitting, praying for such 
a charter." Do you know whether there is a copy of this petition in 
the archives of the State Medical Society? Mrs. Stephens does not 
claim ownership to the petition, consequently cannot give it to the 
State Society, but we think the petition should be in the safe-keeping 
of that Society. The Dunham family has had possession of the peti- 
tion probably for more than one hundred years. Dr. Lewis Dunham, 
one of the signers to it, was a brother of my wife's grandfather, Dr. 
Jacob Dunham, who was a member of the State Society and its 
Treasurer for several years. The petition was successful in obtaining 
for the State Society its first charter. 

Yours truly, 

David Stephens, M. D. 

The receipt of this letter was acknowledged by the 
Secretary, and the custodianship of this paper was 
accepted whenever it should please Dr Stephens to for- 
ward it. 

New Brunswick, N. J., April 20, 1902. 
Wm. J. Chandler, M. D.. 

Secretary Medical Society of Ntw Jersey. 
Dear Doctor :— Enclosed is. the petition that was found by my 
wife, Mrs. Julia Dunham Stephens, when looking over some old fam- 



lOO MEDICAL SOCIETY OF NEW JERSEY. 

ily papers. The petition is signed by Drs. Moses Scott, Lewis Dun- 
ham, Jonathan Ford Morris and John G. Wall. 
The action of the State Society follows : 

" New Brunswick, 3d Nov., 1789. 
" It being resolved that the interests and respectability of this Soci- 
*' ety would be promoted by a Charter of Incorporation, Ordered, 
•' That Messrs. Scott, Morris, Dunham and Wall be appointed a com- 
"mittee to prepare and present a petition to the Honorable the 
** Legislature now sitting, praying for such a charter." 

** Burlington, 4th May, 1790. 

*• Dr. Scott, from the committee appointed to prepare and present 
" petition to the Legislature praying for an act of incorporation, made 
" report that a bill for that purpose had passed the House of Assem- 
" bly, but was lost in Council. The Society deeming it expedient to 
" make further application to Council, resolved, that the same com- 
"mittee be continued, with the addition of Dr. Howard to their 
" number." 

•* An Act for Incorporating a certain number of Physicians and 
" Surgeons of this State, by the Style and Title of The Medical 
*• Society of N^w Jersey," was passed at Perth Amboy, June 2d, 1790." 

" New Brunswick, 2d Nov. 1790. 
" The committee for obtaining a charter reported that they had 
" been successful in their application, and that a bill had passed both 
*• houses of the Legislature for that purpose. Ordered, That the 
" thanks of the Society be given to the committee for their industry 
*' and attention to this business." 

Yours truly, 

David Stephens, M. D. 

The following is a transcript of the original petition : 

To the Honorable the General Assembly of the State of New Jersty : 
The Petition of The Medical society of New Jersey Humbly Shew- 
eth. That a number of the Physicians of the said State have long 
since formed themselves into a Society by the name of The Medical 
Society of New Jersey. 

That the principal objects of their association has been to improve 
the science of medicine, to alleviate human misery, to correspond with 
and receive intelligence from the like societies abroad ; to maintain an 



DR. STEVENS' RELIC. lOI 

uninterrupted intercourse and communication with one another, and in 
fine» to cultivate liberality and harmony among themselves, and to pro- 
mote uniformity in the practice of physic. 

That altho this Association hath in some degree answered the 
expectation of its members, yet from long experience they have found 
that its great objects cannot be fully obtained without the aid of the 
legislative authority to enable them therefore to carry into effect the 
great purposes of the Society, to enable them to make laws and 
regulations for the admission and government of their own members, 
to enable them to keep with safety such useful curiosities of the vege- 
table and mineral families and others as may be discovered in their 
own country, or be sent them from abroad, to record and preserve 
their discoveries and experiments, and the success of their various 
investigations, and also to give them a public name and recommend 
them to the notice and attention of the colleges of physicians abroad 
and in the neighboring States, they have thought it expedient to present 
themselves to the honorable house and to pray that they may be 
created a body corporate and politic in deed, fact and name, with per- 
petual succession ; and that for this purpose they may have liberty to 
present to this house at their present sitting a draught of a charter 
of incorporation for the consideration of and passage (by) this 
honorable house, and the more fully to disclose the principles and 
objects of their Association, as well as its extent throughout this State, 
they beg leave to present this their petition, with a copy of their orig- 
inal constitution, and also of the principles and objects of this present 
Association, accompanied with a list of the names of the members, 
and also a resolution of the Society appointing the subscribers a com- 
mittee in their name and behalf to prepare and present this petition. 
All which they most respectfully submit to this honorable house in 
full confidence that a disposition to promote science and the useful 
arts in general, and especially that which more immediately has in 
view the preservation of health, the care of diseases, and even the 
diminution of mortality itself, will induce them to lend their aid to 
the Medical Society of New Jersey and grant them the privileges 
prayed for in this their petition. 



And your petioners, &c. 



Moses Scott. 
Lewis Dunham. 
Jonathan Ford Morris. 
JNO. G. Wall. 



i02 medical society of new jersey. 

Nurses' Organization. 

Camden, N. J., June 17th, 1902. 
To the Medical Sociity of New Jersey : 

Gentlemen : — At a stated meeting of the New Jersey State 
Nurses* Association a resolution was passed requesting the Medical 
Society of New Jersey to express its approval of the objects of this 
Association. 

The objects of our Association are: The registration and organiza- 
tion of nurses and the securing of such legal enactments as may be 
necessary thereto ; the advancement of all interests which appertain 
to the betterment of the nursing profession, and the establishment of 
a professional reciprocity between the nurses of New Jersey and the 
nurses of other States and countries. 

Trusting that these objects may meet with your approval, we are, 

Respectfully yours, 

Effa Fabringer. 



PRESIDENT'S ADDRESS. 

BY JOHN D. McGILL, M. D., JERSEY CITY. 



Gentlemen of the Medical Society of New fersey : 

It is my pleasant duty this evening, as President of this distinguished 
and venerable nnedical Society, following a time-honored precedent, to 
address you. 

I congratulate you upon the fact that another prosperous year has 
been added to the many prosperous years which have attended the 
existence of this association in the past. 

Our Society grows in numbers, importance and fame, and each 
annual meeting affords us opportunity to place on record the fact of 
our continuous progress and success. 

As the oldest existing medical society in the United States, it ob- 
tains the respect and consideration of all medical men in the nation, 
and excites in the breast of those who owe it allegiance affection as 
well as respect and veneration. 

The conservatism of our .Society is a noteworthy feature. Its ad- 
herence to time-honored medical precedents and strict interpretation 
of medical ethics is conspicuous. As in times past it has battled 
valiantly for the preservation of the good name and fame of rational 
medicin^ against the heresies of the " pathies " and " isms," so to-day 
it stands as a stanch bulwark against the modern tendency to segre- 
gation in medical science and the development of one particular branch 
of that science to the neglect and detriment of the others. Modern 
medicine, like modern trade, is threatened with individualism. In these 
days medical students are prone to adopt a specialty before they take a 
degree, and perfect themselves in their chosen medical branch to the 
neglect of even the fundamental principles of medical science. 

Specialism in medical practice is undoubtedly of the highest value, 
but it should always be founded upon reliable experience obtained in 
a general practice of medicine for a sufficient time. 

The tendency of the day is to a radical departure from the good old 
conservative traditions of our profession. In former days the code of 
medical ethics was a rule for our guide and conduct, and was revered 
by the orthodox practitioner almost with religious fervor. 



104 MEDICAL SOCIETY OF NEW JERSEY. 

To practice medicine as the "code" provides requires culture, 
refinement, and other features of a gentleman. It has been truly said 
that the profession of medicine is the most glorious of professions but 
the meanest of trades. Unfortunately, the modern tendency to utili- 
tarianism in medicine has undermined the healthy and restraining 
influence of the ethical code, and our profession, if the degeneracy of 
the times continues, bids fair to be hereafter conducted upon *' busi- 
ness principles." Even in the matter of the prescription of drugs, the 
old methods are considered obsolete, and the pharmacopoeia, or 
authoritative standard for the preparation and use of drugs, is neg- 
lected for the countless array of proprietary nostrums, and even pat- 
ent medicines. When it is considered that the pharmacopoeia contains 
formulae, the concentrated results of the experience of able and learned 
men, vastly superior in therapeutic virtues and pharmaceutical skill of 
composition to these proprietaries, little excuse, except ignorance of ma- 
teria medica and pharmacy, can be offered for their use. Let us, then, 
the meml^ers of this conservative and ancient State medical society, 
resolve, that, as far as is within our power, we will adhere to the time- 
honored ethics of our profession. 

That while progressive in all that concerns our art, we will refuse 
•to adopt theories, methods or means until the light of reason and ex- 
perience has proved them to be based upon true scientific principles. 

Progress in medical science is always desirable, and research therein 
and practice thereof ought to be free and unrestricted within scientific 
and reputable limits, but such license must not be confbunded with 
a liberalism that is but a disguise for empiricism. 

Perhaps those of us who have grown gray in the service, and who 
lack the enthusiasm of youth, may be prone to adhere to the old ways 
and ideas of yesterday rather than those of to-day, but the conviction 
is irrepressible within us that in matters which concern our code of 
ethics a renaissance would without doubt improve the practice of 
medicine. 

I will direct your attention lo-night to a subject which is so vast 
and broad in its scope as to be almost unlimited, and which to com- 
petently discourse upon would require such exposition as the limited 
time at my command inhibits. Therefore my remarks must necessa- 
rily be brief and general and restricted to certain phases of the ner- 
vous system, with especial reference to medico- legal medicine. 

The general character and description of pathological conditions 



president's address. 105 

which are included in this branch of medical science appear to be 
exceptionally susceptible to nervous influence and to generate neurotic 
morbid states. I have reference in particular to traumatic conditions 
depending upon accidental causation, and where an attempt is made 
by process of law to recover personal damages therefor. In this class 
of cases the patient is almost irresistibly impelled to either assume 
or exaggerate physical disabilities, and this phase of a case should not 
be lost sight of in making a diagnosis. 

Malignerers in a great majority of cases will attempt deception by 
claiming to suffer from some functional nerve disorder where the 
symptomatology is subjective. 

In a great number of the cases where legal questions may rest 
upon the dictum of medical science, the question will pertain to mental 
responsibility in determining guilt for crime; or to mental capacity to 
execute a will or to manage personal affairs. 

To the student of medical science in general the study of the ner- 
vous system, its anatomy and histology, its physiology and pathology, 
while a difficult task, is, nevertheless, one of absorbing interest. 
Especially is this so at the present day, when modern experiment and 
research has added so much to accurate knowledge of the subject. 
The importance of a thorough comprehension of a vital system in the 
human body that more than any other system offers for consideration 
phenomena which will explain its states in health as well as in disease 
is unquestionable. It may be said with truth that the very soul itself, 
that mysterious agency that makes man a superior creature and ele- 
vates him above his fellow animals, depends upon nerve matter for its 
demonstration. 

In that branch of medical science known as medico-legal medicine, 
the nervous system occupies a position of paramount importance. 

In the many and diversified conditions of disease that here present 
themselves for consideration, the nervous element is of predominent 
influence. 

The nervous system in its relation to medico-legal medicine may be 
considered under two divisions — 

I St. Physical. 2d. Psychical. 

Under the first division, physical, may be included all phenomena 
of disease or injury which involve nervous disturbances in the organs 
or tissues of the body. Under the second division, psychical, all phe- 
nomena of disease or injury which involve disturbance of the mind. 



I06 MEDICAL SOCIETY OF NEW JERSEY. 

First the physical. In its arrangement in the human body the nervous 
system differs froni the muscular, osseous or glandular in that it is 
continuous in its composition and distribution. It is composed of 
contiguous nerve cells and fibers ; through these fibers are conducted 
molecular waves of stimulation from one nerve cell to another. The 
process is described as ** invisible physiologic continuity of trans- 
mission." Nerves may be divided into two classes — i. Central. 
2. Peripheral. This classification is perhaps too general to be in 
conformity with the usual anatomical arrangement, and at variance to 
some extent with morphological relations, but is convenient for the 
purpose of pathological study. 

By central is meant the primary or essential nerve trunk known as 
the cerebro-spinal axis. 

By peripheral is meant the secondary or subjective nerve trunks and 
branches ramified throughout the body but without the calvaric cham- 
ber and the spinal canal. 

Within the calvarium are situated the cerebrum, cerebellum, pons 
variolii and the medula oblongata. Within the spinal canal is the 
myelon, or spinal cord, from which branching off in pairs are the 
spinal nerves. Two chains of ganglia lying on each side of the spinal 
column, originally outgrowths of the spinal cord, and closely associated 
with the spinal nerves, constitute the sympathetic system of nerves. 
The function of this so-called system is to innervate the abdominal 
viscera, the organs within the thorax, the glands of the body and the 
involuntary muscles ; while not voluntary in its action, it is neverthe- 
less under the control of the central nervous sy$tem. 

Nerve function exhibits two characteristics — motion and sensation. 
Both are involved in nerve action, which may be reflex or voluntary. 

Reflex action represents a simple co-ordinated nerve reaction, auto- 
matic in character. Necessarily it is localized — that is, segregated. 

The reflex affuent stimulation of the body is continuous, and the 
efferent impulses of the body are incessantly in action. The mechan- 
ism of reflex action consists of a stimulus applied to a sensory nerve, 
the effect of irritation of the stimulus is carried to a nerve centre and 
there is changed to a motor impulse and retransmitted to the original 
area of stimulation. 

Voluntary action is always attended with consciousness and de- 
pends upon the will power to excite it. 

Certain localities of the cerebral cortex of the brain are endowed. 



president's address. 107 

with motor and sensory functions. These functions differ from the 
automatic reflex function of the gray matter of the spinal cord in that 
they are psycho-motor and psycho-sensory phenomena, and depend 
upon " recalled " or ** memorized " impulses for action. 

The muscular system in its errors of function, due to lesion or dis- 
ease, gives evidence of disturbed nerve supply and action by loss of 
motility and. sensation. Characteristic muscular action attends the 
presence of many nerve diseases and diseases and lesions in which 
the nerves are involved. 

In spinal injuries the muscular action, especially as to the body pos- 
ture and gait, is distinctive. Impairment of the muscular sense 
requires the body in its movements to be guided by the eye, and hence 
inco-ordination of muscular movement results. 

The Romberg symptom is of diagnostic importance in spinal and 
some other nervous diseases. The patient is placed in the erect posi- 
tion with the feet together and the eyes closed, when the body sway 
is seen to be exaggerated. This symptom, with elaborations, is much 
in vogue in medico-legal examinations to test co-ordination of muscu- 
lar power. 

Muscular motion is generally increased in nervous diseases espe- 
cially of organic character and affecting the central nervous system. 
The muscular reflexes constitute a most important class of symptofns 
by which to determine ihe character and locate the situation of nerv- 
ous diseases. Spinal localization especially depends upon them. The 
importance of the muscular reflex is both in its being positive and in 
its being negative. 

In medico-legal medicine the muscular reflex is of doubtful value 
except under certain circumstances when its indications may be cor- 
roborated by objective phenomena. Reflexes may be inhibited at will, 
and unless the proper conditions can be secured for testing them, that 
is, complete muscular relaxation, the result will be unsatisfactory. 
The reflexes possible are almost as numerous as the muscles of the 
body. 

The nutrition of the body depends upon the integrity of the peri- 
pheral nerves acted upon from the anterior motor cells of the spinal 
cord. If disease or injury affect this portion of the spinal cord the 
efferent nerves therefrom are powerless to act, and in consequence 
the nutrition of the parts to which those nerves are distributed 
suffers, emaciation results, with loss of power. The term *' trophic" 



I08 MEDICAL SOCIETY OF NEW JERSEY 

is applied to such a condition. The peripheral nerves involved in a 
trophic area will undergo degeneration, secondary to the motor cells 
of the spinal cord. Trophic systems are objective, and, therefore, are 
of value in medico-legal cases. 

Where stimuli without the body or within it are received and 
changed into sensations, the nerve mechanism involved is similar in 
character to that developed in obtaining motor impulse. The faculties 
of sense are sight, hearing, touch, smell and taste. Modifications 
and aberrations of sense perceptions are symptomatic of nervous dis- 
orders, both functional and organic. The symptomatology of abnor- 
mal sensation, if dependent upon functional nervous disease, is largely 
subjective, and hence is of doubtful utility and value in medico-legal 
medicine, but when the disease rests on a structural basis, and 
through the aid of instruments degeneration of appreciable nerve 
tracts may be determined, it is of great value. 

The use of the opthalmoscope is an example. This instrument will 
often add sufficient light in an obscure disease where the organs oi 
sight are involved to make a diagnosis positive. The sensation of 
pain while classed as subjective in its symptomatology, when severe, 
gives rise to typical general symptoms which will objectively prpve its 
existence. The muscular sense may locally also show pain object- 
ively when spasm effects a muscle. Normal sensations may be dis- 
turbed by lesions in any part of the sensory paths throughout the 
entire nerve system. 

Disease or injury to particular nerves may be determined by limita- 
tion of loss of sensation to the area of skin where the nerve branches 
are distributed. 

While, as already stated, errors of sensation unsupported by posi- 
tive objective evidence of causation are subjective and within the 
possibility of simulation, yet as symptoms in medico-legal examina- 
tions they are of value for the reason that it is practically impossible 
for any but an extraordinary malignerer to make them logical. The 
nervous system physically offers the medico-legal diagnostician many 
valuable phenomena upon which he may determine the existence of 
disease or injury. The evidence it offers of conditions existing is in 
the main satisfactory, and, indeed, in the majority of cases, is the chief 
dependence for diagnosis. 

Briefly summarized, physical disease of nerves depend upon two 
causes — ist. Functional disturbances. 2d. Organic lesions. 



president's address. 109 

Function is the appropriate action of a special organ. Particular 
function, then, appertains to each organ of the body and depends 
upon the normal innervation of that organ for its operation. When 
the nerve supply is disturbed functional derangement of the organ fol- 
lows. The dynamic force, that is the energy or power, of the organ 
alone is involved in functional disease, and not its substance, which 
remains apparently unchanged. While th^ operation of an organ in 
performing its function in relation to its mechanism is a mechanical 
process, yet this operation is under nerve control, and through this 
nerve implication it receives and gives nervous sympathy to other 
organs of the body, so that when functionally deranged, it will sym- 
pathetically derange these other organs, particularly organs with 
which it has close and homogeneous relations. Functional disease 
being free from a material basis offers only subjective symptoms upon 
which a diagnosis may be founded. 

No class of cases within the limits of medico-legal medicine pre- 
sents a difficulty of solution greater and cause more embarrassment 
to the diagnostician than the various functional diseases where neu- 
rotic complications are present or where the disease is limited to dis- 
ordered nerve function alone. The diagnosis must be based, as has 
been stated, upon symptoms apparent to the patient alone, and this 
situation offers too great a temptation to a plaintiff who sues for dam- 
ages, or to a criminal who is vitally interested in acquittal, to resist. 
It will happen in medico-legal cases that a combination of subjective 
symptoms may be of such a character that the result upon the body 
in general will produce a condition that is practically objective, a gen- 
eral nerve debility, a true neurasthenia simplex. This combination or 
*• tout ensemble " of symptoms is indicative of general physical disease, 
and is of value in determining the existence of true disability. 

Where physical nerve disease depends upon structural lesioTi, the 
result of transmatism, or is due to the effect of nerve tissue degenera- 
tion, the symptomatology is much more satisfactory upon which to 
base a diagnosis. Objective symptoms are in evidence, and assist 
materially in proving disease with physical disability. As an objective 
symptom proceeds from a condition of disease capable of perception 
by one or more of the special senses, and this perception being sub- 
mitted to the reflective consciousness of a competent intellect, it 
becomes of positive value in the diagnosis of disease, and hence is the 
mainstay in medico-legal practice. 



no MEDICAL SOCIETY OF NEW JERSEY. 

2d. The psychical. To a class or division of nervous disorders 
which depends for its differentiation and symptomatology upon abnor- 
mal manifestations of the mind the name psychical, in contradistinc- 
-tion to physical, has been applied. 

Physiology studies man as a material vital organism productive of 
phenomena the result of functional activity and capable of discernment 
and appreciation by the. senses. If this functional activity or the 
organ or organs upon which it depends become diseased, then, as has 
already been shown, the disease is physical. 

Psychology studies phenomena which are capable of apprehension by 
the conscious mind alone. Consciousness is the power of the mind to 
know itself and its own states. Consciousness may be primary, the 
common state to all sane men, where the mind comprehends its acts 
and the objects of its acts, or it may be secondary, reflective, or philo- 
sophical, where the mind is endowed with natural or cultivated power 
to exercise over its acts and their objects persistence, comprehension, 
comparison and interpretation. 

Psychopathy, psychosis, or psychiatry, are synonomous names, indi- 
cative of the morbid condition involved and applied to diseases of the 
mind where its manifestations are disordered. These diseases are 
classed as functional, but disturbed function may depend upon struct- 
ural degeneration for its causation. The disordered mind of paraletica 
dementia is an example of disturbed function —caused by organic 
disease. Such an instance shows the existence of a mixed type of 
nervous disease where the psychical disorder depends upon an organic 
or physical basis. In this class of neurotic diseases the term physio- 
psychical as a name is suggestive of the pathology concerned. 

The condition of the mind can only be determined by judgment of 
its conscious acts. The mind acts through the exercise of its cogni- 
tive facilities, which are various and commonly described under two 
classes, the classification being based upon their relative importance 
to the intellectual process. 

The cognitive faculties are stimulated to activity in a conscious 
mind by sensory impressions, which may depend upon external objects 
for causation, or the evolution and development of ideas within the 
mind without external stimulation. 

The mental processes may be disordered and become pathological : 

1st. Where the mental conception of sensory impressions caused 
by external objects is at fault and fails of truthful appreciation. 



president's address. Ill 

2(i. Where the mind is not competent to comprehend in a rational 
way its ideation, or where the ideas concepted are in themselves 
unreasonable. 

3d. Where defect in the sensory apparatus causes the mind to 
receive erroneous impressions of external objects, and it arts, as it 
were, on false information. 

In the states described under the first and second of these partitions 
the conscious mind is alienated, and is incompetent to exercise its 
faculties logically. Under the third the mind is normal, but physical 
disease causes erroneous perceptions, which result in false intuitions. 

Action is a result of conscious mental agency, and will be deter- 
mined in its character by the description of mental effort that causes 
it. It will be normal and logical if the mind is sane, exaggerated, 
vagarious and inharmonious if the mind is diseased. 

The faculty of memory may register the impressions of external 
objective sensation, or of intrinsic ideo-conception, and the mind, 
through memory, recall such impressions at a future time. 

A normal or sane mind, then, may be known when the cognitive 
faculties attributed to it are, first, true in their intuitions, and second, 
act with understanding of perceptions transmitted through normal 
sensoria. 

An abnormal mind, which may be an insane mind, is known when 
its manifestations, particularly noted in language and conduct, show 
its intuitions to be false and its comprehension of perceptions defect- 
ive. Many conditions of abnormal mind exist where the mental per- 
version cannot properly be classed with any of the different phases of 
mental disease which distinguish true insanity ; various psychopathic 
hereditic disorders, or psycho-neurotic diseases, have temporary 
aberrations of mind as a part of their symptomatology. 

There may be alienated consciousness in many morbid states. The 
delirium of fevers, intoxication from alcohol or drugs, epilepsy, hysteria 
and chorea, in shock from severe injury, are a few examples ; and the 
consciousness is blunted or lost in trance, somnambulism, coma and 
sleep. In these diseases and states the aberration of mind is tempo- 
rary, and depends upon distinctive causes, and the mind is competent, 
in the absence of the causative factor, to correct delusion, illusion or 
hallucination upon the exercise of simple intuition without even the 
intervention of ratiocination. 

The communication of ideas generated by the mind is through Ian- 



112 MEDICAL SOCIETY OF NEW JERSEY. 

guage or spoken words. Ideas may also be communicated through 
written or printed characters known as letters, and even by gesticula- 
tion and body postures. 

Speech is the voice modified so as to sound words by means of the 
speech mechanism. 

Language, spoken or written, is a manifestation of mental action, 
and may undergo change and.disorder from both physical and psych- 
ical disease. 

Muscular motility and muscular sense may both be indicative of 
psychical disease when influenced by morbid mental action without 
appreciable structural lesion. The nerve action in such cases is vol- 
untary. 

The definition of insanity accepted as descriptive of its pathology 
and moral responsibility by medical science differs from that accepted 
as competent and valid by the law. Ignorance of the nature and 
quality of an act, and an inability to know whether that act is right or 
wrong, will constitute a lawful insanity, and a criminal in such a mental 
state will be held irresponsible for his crime. Unsound mind, mem- 
ory or understanding constitute invalid testamentary incapacity, and if a 
man is incapable of reasonable management of himself or of his affairs 
the law declares him to be a lunatic. A man may be insane medically 
and yet sane by law and responsible for his actions. Medico-legal medi- 
cine is greatly concerned with the question of insanity and testament- 
ary capacity, and must view these subjects from the legal standpoint. 

The immensity of nervous complication in disease, independent of 
morbid conditions affecting the nervous tissues primarily, is almost 
inconceivable. It must be comprehended that no disease or injury 
exists without nervous implication of some character. The nerves are 
always factors to be reckoned with in the diagnosis and treatment of 
disease. Especially is this the case in those cases of traumas with 
which the medico-legal practice is concerned, where the nerve com- 
plication may be both physical and psychical. 

Often in a neurotic diathesis with a comparatively slight traumatism 
the psychical symptoms will be the chief disability, and the patient 
will regard his subjective symptoms with far greater apprehension 
than his physical injury. 

The subjective psychical manifestations in traumatic neurasthenia 
are often of grievous import, especially to the patient. His introspec- 
tion of his symptoms is morbid to such a degree as to be in itself 
symptomatic. 



president's-- address. 1 1 3 

Owing to the fact that a neurotic diathesis is an all-important 
pathogenic factor, especially in physio-psychical and psychical condi- 
tions, a careful investigation of the patient's individual and family 
history is essential. Ativism in neurology is generally admitted. 
Neurotic heredity, and the social evils, either direct or transmitted, 
willcreatea surer foundation for presumption of neurotic diathesis 
than the morphological stigmata. 

I have already called attention to the fact that, as far as may be 
possible in medico-legal conditions, especially where the nervous ele- 
ment predominates, a diagnosis based upon objective symptomatology 
is all-important ; but positive objective symptoms cannot always be 
found, and the diagnosis must frequently be based upon subjective 
symptoms which will corroborate each other. In neurotic conditions 
of physical type, attended either with or without apparent lesion, it is 
well to consider the following points : 

1st. To determine, if possible, a diathesis founded upon a history 
of the case, or anatomical stigmata. 

2d. To ascertain, as far as possible, the physical condition of the 
body by an examination of its tissues and organs. 

In the examination made of the physical organs, the functions of those 
organs ought to be carefully tested as far as practicable. The special 
senses — hearing, sight, touch, smell and taste— all have their organic 
apparatus to receive impressions, and may be generally objectively 
tested. 

The muscular system, with its errors of motion and sensation in 
pathological states, offers very important symptoms for consideratidn. 

Morbid muscular motility will vary from simple asthenia, or tremor, 
to complete paralysis or tonic contraction. 

Sensatjon in disease is characterized by various states and degrees 
of sensibility, from slightly modified esthesia to anesthesia. Disturbed 
motion and sensation, jointly or separately, will indicate significant 
nervous disorders. Again, the conditions of the thoracic, abdominal 
and pelvic organs offer direct or corroborative evidence of neurotic 
disease. 

In the consideration of the psychical manifestations the diagnosis 
must differentiate, first, between simple and morbid psychical phe- 
nomena dependent upon an appreciable cause or physical basis, and. 
second, the various insanities. 

As has already been stated, a sane mind will demonstrate itself 



114 MEDICAL SOCIETY OF NEW JERSEY. 

through the operation of its cognitive faculties, and the correct way 
to determine mental conditions is to test separately these faculties and 
compare each with an approximately normal standard. The presence 
of a delusion, illusion or hallucination do not, in themselves, prove 
insanity. The sane mind, by process of reasoning, will correct its 
consciousness of alienation, or, if vitiated perception is due to par- 
ticular physical cause, the abatement of that cause will restore the 
mental sanity. In the insane, the delusion, illusion or hallucination 
is fixed, and it is not possible for the mind to correct its error. The 
power of reason, in the sense that reason always implies appreciation 
of the truth, is lost. The process of mental action is illogical, since 
it is based on a conviction which is false, yet to the insane mind it 
is a conviction of truth, and the insanity lies in the fact that a con- 
ception of the truth is impossible. 

The subject of psychical disease is one of great moment in medico- 
legal medicine. An action for damages, it has been held by the 
courts, is valid if only the evidence shows psychical shock due to the 
circumstances of accident, and such cause may be the sole etiological 
factor in a neurasthenia and hysteria, especially if coexistent with an 
underlying diathesis. 

The best developed type of psychical disease, and the most import- 
ant from a medico-legal standpoint, is to be found in the various insan- 
ities, which in their symptomatology illustrate almost every description 
of morbid or alienated psychology. 



the pathology of appendicitis. ii 5 

The Pathology of Appendicitis. 

(from a histological research of fifty cases) 
by george e. mclaughlin, m.d.. jersey city. 

My paper is based upon the study of the stained sections of fifty 
different vermiform appendices, which were removed for the cure 
of appendicitis. I have endeavored, also, to combine the thoughts 
of the latest writers upon this subject, in many instances using their 
words, for which I have given them due credit. To better elucidate 
my work I have prepared lantern slides from some of the different 
sections to illustrate the pathological changes found. If I wander 
slightly from the pathology into the bacteriology, I trust you will 
grant me your indulgence, as my object has been to make the subject 
interesting and not too purely scientific. 

History. — I cannot pass on without a few words concerning the 
recent history. 

*' The epoch-making memoir of appendicitis is the paper of 
Reginald Fitz, of Boston, published in the American Journal of the 
Medical Sciences for October, 1886, on * Perforative Inflammation of 
the Vermiform Appendix/ In this work Fitz collected reports of 
209 cases of typhilitis and peri-typhilitis and 257 cases of perforative 
appendicitis. He shows that the symptoms are the same in both 
classes of cases. He studied, with care, the consequences of perfor- 
ation. He established the fact that peritonitis is not always general- 
ized, and that it may be circumscribed under the form of an encysted, 
purulent collection. He gave the characters of the tumors formed by 
this localized peritonitis, the different modes of evacuation of pus. 
the complications that may supervene, if the disease be left to itself. 
He insisted on the frequency of fecal concretions as a cause of perfor- 
ation of the appendix. He concludes in favor of early operations." 

In 1888, Fitz published a second paper, in which he advanced the 
radical but sound theory, that the diseases described as typhilitis, 
peri-typhilitis, para-typhilitis, appendicular peritonitis, and peri- 
typhilitic abscess, were all varieties of one and the same affection, 
namely, appendicitis. 

To McBurney's paper, read before the Medical Society of the State 
of New York, in 1891, belongs the credit of bringing the early surgical 
treatment of appendicitis into prominence. 



Il6 MEDICAL SOCIETY OF NEW JERSEY. 

Ostler, in 1892, published the first text-book, in which nearly all 
cases of typhilitis were directly stated to be appendicitis. 

Assisted by Fitz, the surgeons of the United States have demon- 
strated by early operation that, practically every case of inflammation 
of the right iliac fossa, is due to disease of the vermiform appendix, 
and have restored this moot question to the status to which Melier, in 
1827, advanced it. 

Use of Clinical Terms. — My investigations into the realm of his- 
tology of appendicitis very early impressed me with the fact of the 
existence of many terms used to express the appendicular condition, 
and I soon appreciated the importance of a proper nomenclature 
based upon a scientific study of the pathology. Were we to speak of 
*' relapsing appendicitis," •' perforative appendicitis," or " recurrent 
appendicitis," some might be lead to think that there was one kind of 
appendicitis which was prone to relapse, and another to recur, while 
others, that perforative appendicitis was a particular kind which 
was characterized by perforation. The same reasoning applies to 
gangrenous appendicitis and ulcerative appendicitis. 

Asked for a correct nomenclature, I should adduce the term 
" tuberculous appendicitis." It implies the cause of the inflammation, 
the presence of the tubercle bacillus, and a sequence of morbid 
changes, including ulceration and perhaps perforation. It permits us 
to speak of tuberculous ulceration and tuberculous perforation, and 
the mind imagines a definite morbid process with a definite cause. 

Niemeyer states that " catarrh consists of engorgement oi the blood 
vessels of any mucus membrane, accompanied by abnormal secretion, 
swelling, succulence of the tissues, and copious generation of young 
cells." I have found, however, that modern methods^ of histological 
research almost invariably show that appendicular catarrh is only a 
small part of the disease and not the essential part. Some of my 
sections showed what I at first believed was a catarrhal condition, 
but, which, on further investigation, usually proved to be ulceration 
with bacterial invasion of the mucosa. 

Talamon's expression, ** appendicular colic," is also open to objec- 
tion. In a typical case of appendicular colic, in which small concre- 
tions were present, the appendix showed edema of all the coats, 
destruction of lining epithelium, and bacteria, beginning to penetrate 
the mucosa where it had lost its epithelium. In a purely clinical 
sense the term is convenient to imply the clinical symptoms which are 
found in the early stages of ulceration. 



THE PATHOLOGY OF APPENDICITIS. 11/ 

The terms recurrent and relapsing also indicates clinical peculiar- 
ities of appendicitis. They do not indicate in the least the morbid 
changes which account for the relapse or recurrence. 

Cause of the Morbid Changes. — It is quite correct, to say, that in 
general the histology of the vermiform appendix conforms to that of 
the large intestine, but, in so saying, we must not loose sight of the 
differences which do exist. One great difference is the presence in 
the mucosa, or mucus membrane, of the appendix of a large amount 
of lymphoid tissue, arranged as circular bodies, which infiltrate the 
mucosa and collect in definite groups called lymphoid follicles. It is 
because of this richness in lymphoid tissue that the appendix has been 
aptly compared by Sutton to the tonsil, and in fact called the abdom- 
inal tonsil. 

Golubof regards the majority of appendicitis cases as instances of 
an infectious disease as peculiar to the appendix as follicular angina 
is to the tonsil or dysentary to the large intestine. 

Adrian's work, just 'published from Naunyui's clinic, is the most 
recent and important work on experimental appendicitis. He suc- 
ceeded in producing appendicitis in rabbits by intravenous injection 
of suspensions^of bacteria. Of great interest is his demonstration, 
that in those blood infections the follicular inflammation of the 
appendix is visible macroscopically some time before the other portions 
of the intestine exhibit, either gross or microscopic lesions. In other 
words, given bacteria circulating in the blood, the lymphoid tissue of 
the appendix is a seat of predilection for their early deposit and 
growth. 

A frequent condition in appendicitis is the presence of fecal con- 
cretions. Once present, they must be regarded as important factors, 
predisposing to attacks of inflammation. Acting as a mechanic, and 
perhaps, chemical irritant, a lesion of the appendicular mucus mem- 
brane may result and a favorable nidus for the. ever present colon 
bacillus or pyogenic cocci is created. In cases where the appendix 
is plugged by these concretions or a stenosis, which may be brought 
about by past inflammatory contraction, the conditions for drainage 
are imperfect and the virulence of the organisms present in the secre- 
tions thus dammed up is increased, and thereby favors the outburst 
of an inflammatory attack. Foreign bodies are analogous. In either 
case coprolith, or foreign body, infection is the immediate cause. 

Klecki has indeed demonstrated this heightening of virulence of 



Il8 MEDICAL SOCIETY OF NEW JERSEY. 

micro-organisms in a loop of intestine enclosed,between two ligatures. 

In health, the appendix empties itself of accumulated secretion 
and fecal matter, by its normal peristalsis. We are now aware that 
defective drainage is one of the most important factors in the pro* 
duction of appendicitis. There still remains, however, numerous 
instances of appendicitis in which there is no opposition to free 
drainage. 

Reclus endeavors to explain a certain number of these cases under 
the title of " Propagated Appendicitis " ; that is, appendicitis resulting 
from an extension of inflammation from neighboring intestinal mucosa, 
a sequel or an accompaniment of an antefo-colitis. In the appendix 
this inflammation has far-reaching results, to explain which Reclus 
has invoked his theory of stagnation, and consequent increase of bac- 
terial virulence. He points out that the appendix is a blind tube. " It 
is a diverticulum opening into a diverticulum ; it is a cecum of the 
cecum ; its narrow canal descends along the iliac fossa, and matter 
passing from the intestines into its cavity, as well as the mucous 
which its wall secretes, must struggle against gravity to pass back 
into the intestine." Thus are produced the conditions for stagnation, 
if not obstruction, as in the calculus forms, and whereas in other por- 
tions of the intestines everything is relatively favorable for the heal- 
ing of an enteritis, of slight ulceration and inflammation, in the 
appendix it is otherwise, for here the increase of bacterial virulence 
in the stagnating material may render the inflammation more intense, 
more persistent, and subject to acute exacerbations, just as in blind 
fistulas suppuration is wont to exist until by the art of the surgeon 
the conditions for free drainage and removal of stagnating material are 
produced. In this way does Reclus elucidate the results, seemingly 
disproportionate of extension of inflammation from the neighboring 
intestines to the appendix. 

Some degree of abdominal distention is seldom absent in appendi- 
citis, and the gravity of the disease is in direct relation to the amount 
of distention. Where there is inflammation of the colon, cecum, 
or end of the ilium, these portions become paralyzed so far as peri- 
stalsis goes, and so allow of accumulation of gas or distention, the 
amount of peritonitis governing the extent of paralysis. 

Classification,— \ prefer to use Lockwood's classification, many of 
whose objections to other terms I have given above. I use the word 
appendicitis to express any kind of inflammation of the appendix, and 



THE PATHOLOGY OF APPENDICITIS. II9 

use it in conjunction with other words intended to convey an idea of 
the leading characteristics of the disease. The arrangement is 
somewhat artificial. In most cases the groups do not consist of sep- 
arate and distinct diseases of the appendix, but of stages of the same 
disease. Classified according to their pathology, we have the following 
groups : 

1st. Appendicitis with ulceration of the mucosa. 

2d. Appendicitis with ulceration of the mucosa and bacterial 
invasion. 

3d. Appendicitis with ulceration of mucosa, and with fecal concre- 
tions, foreign bodies, and their complications. 

4th. Appendicitis with stenosis and its complications (cysts, 
mucocele, empyema, ulceration and bacterial invasion). 

5th. Appendicitis with sclerosis and obliteration of the lumen. 

6th. Appendicitis with lymphangitis and lymphadenitis. 

/th. Tuberculous appendicitis. 

8th. Appendicitis complicating malignant and other diseases. 

Symptoms in Relation to Pathological Changes, — The usual 
symptoms of appendicitis are pain in right iliac fossa, constipa- 
tion, vomiting, abdominal distention, raise in temperature, and 
acceleration of pulse and respiration. But these symptoms usually 
belong to the second phase of appendicitis in which the inflam- 
matory process has had lime to spread to lymphatics, veins, periton- 
eum and adjacent* structures. The first phase is that in which 
ulceration of the mucosa is spreading, strictures forming, and concre- 
tions growing, but a diagnosis at this time is seldom made. 

Ulceration and concretion. While gangrene may occur in a few 
hours, ulceration of the mucosa is a slower process. Ulcerations with 
concretion is usually attended with constant discomfort amd occa- 
sional attacks of pain. 

Fecal concretion, — Cases of fecal concretion are usually slow in 
early stages, because the growth of the concretion is slow, and 
because the accompanying ulceration is of the chronic type. The 
ultimate ulceration, perforation and gangrene is usually rapid, and 
may be brought about by some unusual disturbance, such as exposure. 

Stenosis, The cases of stenosis are still slower, the process taking 
considerable time. Finally, however, when the occlusion is complete, 
the pent-up contents cause continuous and maybe severe clinical phe- 
nomena; a good deal depending upon the nature of the pent-up con- 



120 MEDICAL SOCIETY OF NEW JERSEY. 

tents. These cases often give short, sharp attacks of appendicitis 
with intervals of apparent recovery. 

' Slight ulceration with bacterial invasion. — Slight ulceration with 
bacterial invasion is characterized by symptoms of appendicular colic 
and culminates in appendicitis. 

Chronic ulceration with bacterial invasion. — Chronic ulceration 
with bacterial invasion is characterized by severe attacks of appendi- 
citis, usually by painful tumor, by persistence of pain, and alimentary 
disturbance and variable temperature. 

Lymphadenitis and lymphangitis.— In lymphadenitis and lymphan- 
gitis we have severe and repeated attacks, and it is difficult to distin- 
guish between this and other acute forms. 

Empyema. — Empyema of appendix is accompanied with frequent 
attacks of appendicitis, and in the interval pain, increase in tempera- 
ture, anaemia and alimentary disturbance. 

Mucocele. — Mucocele of the appendix is characterized by hard and 
painful tumor, frequent attacks of pain, moderate in intensity and 
duration, and disturbed digestion. Temperature and pulse are but 
little elevated during an attack. 

NUMBERS OF CASES AND TYPE. 

Ulceration without bacterial invasion being found, - 3 

Ulceration with bacterial invasion, - - - 30 

Ulceration and fecal concretion, - , -. - - 10 

Stenosis and complications, - - - - 3 

Obliteration of lumen, ------ i 

Lymphadenitis, ------- 1 

Tuberculosis. ---i 

Myxoma, - -.- - - - - - i. 

LITERATURE 

1. Text Book of Practical Medicine, Niemeyer, 1878. Vol. I., 
page I. Translated by Humphreys & Hackly. 

2. Appendicitis. C. Lockwood. 1900. 

3. Adrian/ Mitth. aus d Greuzgeb d Med. u Chir. 1901. 

4. Golubof. Berl. Ke. Wochenschr. 1897. 

5. Reclus. Sem. Med. 1897. 

6. Klecki. Annals Pasteur Institute. 1899. 

7. Finner & Hamburgher. American Med. 1901. 

8. Deaver. Treatise on Appendicitis. 1900. 
9. Sutton. Lancet. 1891 



THE RURAL SURGEON. 121 



The Rural Surgeon; His Place, Privilege and 

Duty. 

BY A. W. TAYLOR, M.D.. THIRD VICE-PRESIDENT, BEVERLY, N. J. 

No definition of title is necessary. In order, however, that a perfect 
understanding may exist, I would use the adjective •* rural '* as applying 
to and including all of that class of professional men found outside of 
cities having a population of 5,000 or more ; thus including populous 
districts and sparsely settled sections. 

In the popular modern acceptation of the term a surgeon is one 
who only, or chiefly, applies his professional attainments to the cor- 
rection of human or animal physical abnormalities or irregularities, 
and in the treatment of them depends largely upon mechanical appli- 
ances and instrumental means as the most appropriate source of 
relief. This, however, does not accurately define our subject, as the 
rural surgeon must combine surgical work with medical practice. 

The medicinal and dietetic methods and treatment employed by the 
surgeon sltq, first, to well prepare his patient for the operative pro- 
cedure ; second, to annul pain and prevent collapse during the opera- 
tion, and third, to enable the patient to recover from the shock and 
the damage done by the operation and the disease, disturbance or 
injury which made operative interference necessary. 

No man can be a surgeon profitably to his patients until he has 
been thoroughly grounded in both the theory and practice of medicine. 
If, then, in addition to his collegiate course, he has passed the trying 
ordeal, successfully, of one or more State medical board examinations, 
he may be considered a safe man to turn loose upon a critical and 
confiding community. 

The three fundamental essentials of knowledge are said to be the 
three Rs, viz , Reading, Riting, and Rithmetic. We may also claim 
that the three essentials to the making of a good surgeon are the 
three Ns, viz., Nerve, Nowledge, and the Nife. In times not far 
removed from our own, in fact within the memory of some of the 
members of this Society, it was as much the nerve of the operator as 
his skill, knowledge, and the adaptability of his instruments to his 
Work that made the surgeon. Then rapidity and dexterity of opera- 
tion were exceedingly important factors in even the minor operations ; 



122 MEDICAL SOCIETY OF NEW JERSEY. 

major operations could not be done except when (in the words of 
Keen) '* attended with horrors which those who live in these days 
cannot appreciate." ** Every second of suffering saved was an incal- 
culable boon." 

Anaesthesia, introduced within the lifetime of most of us, first 
changed the whole aspect of the surgical art, and the ampitheatre 
which had been the place of unspeakable horrors and indescribable 
hurry and confusion, became a spot of quiet and scientific work, in 
which no writhings nor contortions took place, and the surgeon could 
calmly perform his work. Haste ceased to be a factor, and accuracy 
of detail with scientific deliberation and skill took its place. Other 
opprobria of the older surgery were the profuse formation and 
discharge of pus, and the irritating unabsorbabie sutures and liga- 
tures. These things, too, have become memories to most of us, as 
antisepsis has driven the first to the wall, and the second has been 
replaced by the absorbable animal ligature and suture. 

One more factor has much aided the modern surgeon in his work^ 
and that is the trained nurse. She is not selected haphazard, but 
after a probation of w6eks or months is deemed fit to begin the study 
of nursing. After this she has a long and rigid course of hard prac- 
tical training before she is considered qualified to enter upon her 
work. These three iiems, anaesthesia, antisepsis and the trained 
nurse, have robbed surgery of its terrors ; and so, aided by these, and 
armed with the thorough education now given to the medical student 
in lecture room and laboratory, clinic and hospital, the M. D. who 
locates far away from the noise and tumult of the city need not feel 
that he lacks either opportunity or right to combine surgical and 
medical practice. 

This is the day of the specialist, and it is well that the various sub- 
divisions exist. Each has its place, each is necessary, and each has 
had a prominent share in the advancement of surgical science. Their 
multiplicity, however, has not been without danger to the practitioner 
removed from the busy metropolis ; and that danger lies in the facility 
with which he can refer any obscure case to his city brother who has 
made this particular type his specialty. It has lessened the grind, and 
persistent reading and observation, which the country doctor formerly 
found necessary, and has made him somewhat of a professional 
clearing-house, who refers his ear cases to Dr. A, his eye cases to Dr. 
B, his heart cases to Dr. C, his appendiceal cases to Dr. D, and so on, 
almost ad infinitum. 



THE RURAL SURGEON, 1 23 

Now, what is the place of the rural physician and surgeon ? His 
diploma asserts that he has proved himself proficient in medicine and 
surgery. The State Board has put him through a gauntlet of 
questions, many of which the examiners themselves could not have 
answered without special research. Last of all the doctor has put 
out his modest sign which asserts that this is the office of Dr. Blank, 
Physician and Surgeon. The place of this man is just what his edu- 
cation, the law and his own assertion on his window-sign have given 
him. He should be to his community both physician and surgeon. 
He should no more refer the minor surgical work to his city brother 
than he should his ordinary medical cases. He should be equally 
ready to remove a splinter or amputate an arm. 

The country doctor much more than the city physician is the family 
friend and adviser. His advice is sought as to many other matters 
than physical ills, but in the professional line he should be able, not 
only to advise what should be done, but also be able to do it. He 
should be the Dr. MacLure of Drumtochty fame. I do not think that 
the major operations of surgery should ordinarily be undertaken by 
any other than those who have been made more or less familiar with 
them ; in the first place by assisting in their performance, and later 
by operating themselves. Even this restriction, however, is much 
less of a limitation than formerly ; for clinical and hospital experience 
are the privilege of all medical^ students of the present day. Oper- 
ations upon the brain, chest and abdominal cavities should probably 
be left to those that have a larger armament in the way of instruments 
and experience than has fallen to the lot of the ordinary practitioner. 
It should be, however, the place, privilege and duty of any physician 
remote from city hospitals and their professional aid. to perform most 
of the operations required by acute difficulties. The chronic surgical 
troubles of the brain, bones and cavities of the body had better be 
referred to the specialist. But, why should a depressed cranial 
fracture be left to produce cerebral irritation while the patient is 
bumped and jolted for dozens, and perhaps, hundreds of miles to the 
hospital, or a surgeon summoned from long distance ? Why should 
a case of appendicitis be allowed to die while waiting for foreign aid ? 
A cool head, a clear brain, clean instruments, a clean patient, a clean 
room and a gentle, sensible, positive woman are essentials to good 
" country surgery." These can all be had in most of our American 
homes, and are the essentials, also, of aseptic treatment. Dr. Keen 



124 MEDICAL SOCIETY OF NEW JERSEY. 

says, that in surgical work "it is not so much a question of absolute 
asepsis, as it is of reducing the percentage of micro-organisms to the 
point of inocuousness." 

The conditions of asepsis are not always available, instantly, in the 
country, but can be quickly procured or prepared in much less time 
than would be required to prepare the patient for the journey and 
convey him to an hospital. A room, remote as possible from the 
living rooms, with an abundance of air and sunlight can be made the 
operating room, and its wood work and walls having been well 
washed with a bi-chloride solution, after a thorough cleaning, may be 
considered sufficiently aseptic for our purpose. Carpets, rugs and 
curtains should be removed, and after the operation it can be made 
the bed-room of the patient, the floor of which should be wiped daily 
with a cloth dampened with a bi-chloride solution. The operating 
table can be extemporized from the dining room table, or the near-by 
village carpenter can prepare one with boards and trusses, or better 
yet, it is both easy and practicable to have the small portable iron or 
iron and glass operating table. The drug store or the doctor's office 
will furnish lint, bandages, absorbent cotton, sutures, ligatures 
ether, etc. 

As to instruments, every M. D. is supposed to have in his surgical 
case such instruments as are absolutely essential to the performance 
of all the operations of ordinary surgery. It is convenient to have a 
large armamentaria, but it is not necessary. Special operations may 
require special instruments but the cutler's catalogue, with the aid of 
telegraph, telephone, and express, will shortly bring them to your 
door. The family tea-kettle or a new and clean tin-pan can be used 
to boil the*instruments, and washbowls can contain the antiseptic 
hand-washes, as well as the normal salt solution. Clean sheets, 
having been boiled and ironed, are practically aseptic, and can be 
used about the patient. Lint also having been boiled, is to be used in 
preference,'to sponges, and gowns for the operator and assistants can 
be extemporized from clean unused shirts or night-gowns, the boiling 
and ironing of which has made . them closely approach the aseptic. 
With thesejpreparations the operator and assistants are as well pre- 
pared as the hospital staff, having, of course, thoroughly cleansed their 
hands with the antiseptic washes, and bound up hair and beard in 
protective^gauze. 

The rural surgeon will use the same anaesthetic as his city brother. 



THE RURAL SURGEON. 1 25 

and while the skilled administrator may not be at hand, a neighboring 
physician is a good substitute, or a cool and clear headed man or 
woman can help in this, under the direction of the operator. The 
clergyman often makes a good assistant in this respect, as well, also, 
a woman of brain and nerve. In connection with the anaesthesia it 
is well to have the hypodermic syringe near at hand, charged with its 
one-thirtieth grain of strychnia, and also, in case of need, the battery 
and a cylinder of oxygen. 

Now, all this having been attended to, comes the operator's work. 
Here the nerve, knowledge and knife part appears. Anaesthesia has 
eliminated groans, pain and haste, and the patient becomes a mere 
mechanism from which some disturbing abnormal matter is to be 
removed, or in which some misplaced, displaced, or disarranged 
portion needs to be corrected, or broken parts removed or repaired. 
Slowly, cautiously, and carefully the work is done, each tissue 
examined, each bleeding vessel caught, adjacent tissues carefully, step 
by step, examined, and organs protected hy antiseptic gauze ; no step 
being taken until satisfied that it is correct, and thus, with brain, eye, 
and hand alert and active, the cancer is removed, the tumor dissected 
from its surroundings, the abscess evacuated, the broken limb set, 
and all other needed work done. Those who have experienced it 
know that no greater joy comes to jiny one than is felt by the rura\ 
surgeon, when his duty has been successfully performed and his 
patient relieved. 

This is no hypothetical picture. I know of one country doctor, 
laying no claim to being a surgeon other than that his diploma gives 
him, who has for many years, with no professional aid, other than a 
neighboring physician, and generally with unskilled and inexperienced 
assistance performed all of his own minor surgery and ordinary ampu- 
tations. He has several times, with only lay help, amputated limbs, 
has performed Choparts operation, has removed the breast, repaired 
the lacerated cervix uteri, operated for hare-lip, removed uterine and 
nasal polypi, operated frequently for fistula in ano, done his own 
circumcisions, treated fractures and dislocations, and feels that his 
duty to his patients requires this of him. 

Another rural surgeon has gone further than this, and has many 
times successfully operated in severe appendiceal cases ; has per- 
formed ovariotomy, nephrectomy, thyreoidectomy, thoracentesis, 
uterotomy, removed large dermoid cysts and performed many other 



126 MEDICAL SOCIETY OF NEW JERSEY. 

major operations, as well as all of his own minor surgery, and much 
of his neighbors. For the rural M. D. to refer all of his surgical 
cases to the city surgeon or to send them to an hospital, is a shirking 
of duty on his part, an imposition on the charity of those who support 
the hospitals, and oft-times an injustice to his patient, who has a 
right to claim, at his doctor's hands, a prompt relief. 

The family physician has to gnake at least a tentative examination 
and diagnosis before calling in city or hospital aid, and, if he is as 
thorough in his search and examination, manual and mental, visual 
and verbal, as the city consultant, his diagnosis should be the same. 
Too often, it is true, that the rural doctor does not study his cases 
as thoroughly as his city brother. He can do it, if he would. Books 
are plenty and cheap ; libraries are accessible ; medical journals are 
abundant. He can, if he wishes, visit the hospitals and see work 
done, or he can go to the dissecting rooms and work out his case 
on the cadaver ; of course, understanding that the hospital, dissecting 
room and library are not too remote. 

If special nursing is required, the rural, as well as the civic surgeon 
can, in these days of nurses' directories procure a nurse, skilled and 
experienced in the particular kind of a case he is treating. ^ If he does 
not deem it essential to have a trained nurse, he can find in his own 
neighborhood a clear-headed and clean-handed woman, who is a 
benediction in the sick-room, and will not only obey orders, but will 
see that orders are obeyed. We all have one or more such God-sent 
aids in our districts. If, however, the patient can afford it, get a 
trained nurse, if possible, and let the good little neighbor help her. 
I have never seen nor had more efficient help than was once given me 
during an amputation by a little country farmer woman, weighing 
about ninety pounds, who knew enough to keep out of the way when 
she was not wanted, and to be instantly on hand when she was. 

We have shown the means and methods by which the rural 
surgeon or country doctor can do much or most of his own surgical 
work, and we think that there is no difficulty in also showing that he 
can gain both glory and cash by so doing. He is somewhat handi- 
capped by the facility with which the city doctor can run around to 
hospitals, clinics, and brother physicians' offices, and thus gain 
practical knowledge. The country doctor will have to consult his 
library by night aud meditate by day. An eminent Philadelphia 
physician was recently reproved by a friend for placing a wealthy 



THE RURAL SURGEON. I27 

patient in the temporary care of a country physician, when a city 
doctor could have been almost as easily procured. He replied, that 
his faith in the resources of the country doctor as compared with the 
city M. D. was in favor of the country doctor, as 1.17. This, prob- 
ably, was a mere off-hand remark. My faith, however, in the rural 
physician's resourcefulness is great. He is like the traditional 
Yankee boy, *' if there is go in it, he will make it go," and if the rural 
surgeon has not the instruments or appliances he needs he will 
make them, or adapt others to the necessities of the case. Too little 
is known or thought of the shrewdness with which the country doctor 
takes advantage of circumstances, and oftentimes makes of disadvan- 
tage an aid. He frequently demonstrates the fact, that God is on the 
side of him, who, with knowledge, nerve and care ventures to do and 
dare. Successful surgery frequently seems to be a case of skilled 
•daring. 

A doctor will acquire more renown in the country districts from the 
performance of an amputation than from the successful treatment of 
double pneumonia, or a severe typhoid case. This renown will bring 
him more patients and cash than those cases that are quietly fought 
out in the sile.it and shaded sick-room, wearing out body and mind of 
physician and nurse. So, from the sordid personal side, the rural 
surgeon owes it to himself to do most of the surgical work that comes 
to his hand. It is said that he has not the time. Let him work as 
hard as the city physician or surgeon and he will have it. Do most of 
us work as hard as have Agnew. Gross, Pancoast, White, Deaver, 
Noble or dozen of others, men eminent in our profession? They 
study, write and work. The majority of us only work. 

I do not wish to be considered, as, in the least way, depreciating or 
disparaging the city doctor or surgeon. We have, too many times, 
experienced his kindness and skill. He has r^dfA^/^/our wealthy patients 
well, and has often, very often indeed, without money and without 
price, discharged Qwx poorer ones well. God bless him ? We know 
him and reverence him. We think as much of him as Dr. MacLure 
did of Sir George, and he has often served us as well. We think, 
however, that his kindness and skill, his ever-readiness to help in 
time of trouble has led the country doctor, a little too willingly, to 
lay aside the scalpel, and feeling, that perhaps, in his hand the pen 
was more mighty, he writes a note with which he sends his patient 
off to the hospital, and, like Micawber, with his notes, thanks God that 
he is rid of the case. 



128 MEDICAL SOCIETY OF NEW JERSEY. 

My plea is for the doing of our own work to a greater degree. Do 
not send our patients to an over-crowded hospital, when we can do 
what needs doing ourselves. Do not send a hundred miles, or less, 
for a surgeon to amputate a leg or an arm. He will come and perform 
the operation and return with both the glory and the cash, leaving 
you to care for the case. Do the operation yourself and retain both 
glory and cash. 

You will not make any more failures than your city friends. You 
will hear a little more of those you do make, but the chances are 
ten to one that you will take as much or more personal interest and 
care than the city physician could. You cannot afford to have 
" anything happen." You must be on hand and stand criticism. If 
you lose the case you will have to go to the funeral, and would almost 
be willing to change places with your patient, for you well know that 
you will not hear the last of the case formany a long day. You will 
probably, also lose your fee, and your practice among the relations* 

For these reasons, the good, conscientious, thoroughly educated 
and brave rural surgeon is likely to take as much or more pains, and 
to give as much or more earnest thought and careful study to his 
surgical cases than one who, often, rarely sees his patient after the 
operation, and who collects his fee before his departure from the 
house 

The rural surgeon has an important place in the community. He 
is accessible and generally capable. It is his privilege to relieve the 
sufferings of those, who, in childhood, look to him as little less than 
a divinity, in later years as a friend and comforter, and, who, as old 
age and death come to them, feel that the dark valley is less gloomy, 
and its chill less cold, if he be with them in the trying hour. 

It is the duty of the rural surgeon to prepare himself for such 

emergencies, as may demand his aid. His brain and splint-box, 

should both be filled with those things that are needful in first and 

final aid to the injured. Fame may not come to such a one, but the 

consciousness of duty done will be a crown to be proudly worn. 

What after all is fame ? 

'* It is to have when the original is dust 

A name, a wretched picture and a worse bust." 

DISCUSSION. 

Dr. a. Treganowan, South Amboy. — I have listened with a good 
deal of interest and pleasure to this essay, and whilst listening to it I 



THE RURAL SURGEON. I29 

could not help but be carried back to the old days when the rural sur- 
geon was very different from what he is to-day. I cannot help but 
think that although these boys around here brag of their knowl- 
edge, how much more courage we of the olden time had to have than 
the young surgeon of to-day. The latter has only to telephone or 
telegraph or send a message to a neighboring town in order to call ii> 
efficient help. Away back in the " fifties/' when acting as a rural sur- 
geon, if you had an injury requiring, perhaps, amputation of the leg 
or arm, you felt ten times more the weight of responsibility than the 
surgeon of to-day, because you were alone, were entirely responsible^ 
and had nobody to assist you. I can recall cases in which I have 
done major amputations with only the help of a little boy or an old 
woman, who held a tallow candle or a kerosene lamp. When the 
blood began to flow the old woman would keel over, and put out the 
candle or allow the lamp to fall. It is a noticeable fact, and I stand 
here to-day to boast of it on behalf of the medical fraternity of New 
Jersey, that there was a time when it was murder to enter the peri- 
toneal cavity, or the chest cavity, or to do work within the cranium, etc.» 
and when it was a double murder to mutilate the uterus. Apropos 
to the present day antiseptic stirgical precautions: In 1852, just be- 
fore I graduated, there was an old physician living at Norristown 
by the name of Spencer. He, with Dr. Stokes, God bless him, had a 
patient with an ovarian cyst. After a good deal of consultation it 
was decided by the rural surgeon to remove it. . We all met there ; 
I was the assistant to Drs. Stokes and Spencer. The ovarian cyst 
was extirpated, not punctured. It was necessary to get some water, 
and the nearest approach to water that I could get was out in the 
barnyard where the pigs and cows drank. That was the water I got, 
and strange to say, the woman got well. I believe that the removal 
of that ovarian cyst was the first done in New Jersey. I am proud 
to say I was the assistant there, but I hope you will not publish the 
fact that I took the water from the barnyard. 

Dr. T. W. Corwin, Newark. — There is no reason why the rural 
surgeon should not accomplish most excellent work in that department 
of surgery which he feels he understands and is qualified to do. The 
ability to operate promptly and successfully means that the person 
has given attention and study to that particular branch long previous 
to the occasion on which the services are demanded. There can be 
no question that one thoroughly conversant with the principles of 



130 MEDICAL SOCIETY OF NEW JERSEY. 

general surgery and their application to a particular case is w^ll fitted 
to perform any such operation coming into his hands, but I presume 
the hesitation of the rural surgeon, or of any other surgeon, in a par- 
ticular case, depends upon the fact that he is called upon to do so 
many things, that he feels that he has not been able to give sufficient 
attention to this one subject to make him practically familiar with the 
procedures required. I really believe that every one, in addition to 
his general qualifications, should have qualifications for a special 
branch of medicine. If he has so prepared himself he is able and 
should undertake the treatment of operative cases falling in this de- 
partment. The important suggestion of the essay seems to me to be 
that of ample preparation. 

Dr. Henry Chavanne, Salem. — We do not fully appreciate that 
circumstances, conditions and opportunities make the hero. There 
were two men side by side in line of battle on a charge. One of 
them, who was inconsiderate and would meet death anywhere, ob- 
served that his companion was pale and trembling, and turning to 
him said, *' You're a coward." The other replied, " I am not a coward, 
but if you were half as afraid as I am you would have run away long 
ago." This story is applicable to the remarks made by one of the 
speakers concerning the younger surgeons. 

Dr. a. K. Rogers, Paterson. — It is remarkable, in my experience, 
how reading often helps one. You read an article in a journal which 
you think will be of no particular use to you, and yet in the course of 
a yveek that article helps you very much. Some twenty years ago a 
neighbor of mine had a pamphlet describing operations with the aspir- 
ator for the relief of diseases of the chest. The pamphlet was in French, 
and my neighbor could not read it, so he gave it to me. I read the 
pamphlet. A week or two afterwards, in the middle of a cold night, 
I was called to see a man whose bladder could not be emptied. Cath- 
cthers had been tried without avail. The man was suffering intensely, 
and it appeared almost as if he would die. I thought of the instru- 
ment my neighbor had received with this pamphlet. I could only get 
the needles, but I took them to the patient's bedside and passed one 
over the pubes into the bladder, and relieved my patient in five min- 
utes. If I had not' read that I might have hesitated or not have known 
what to do to relieve this poor old man, who was himself a physician. 



present methods of education. i31 

The Present Methods of Education from the 
Standpoint of the Physician. 

BY JOSEPH TOMLINSON, M.D., BRIDGETON, N. J. 

The human race is in a constant stage of transition. Nothing is 
iixecl or stable, and the laws of evolution are incessantly at work 
■changing the status of nations and individuals and bringing them into 
4iew and varied relations with one another. 

The temples of Greece, which, at one time stood as exponents of 
4cnowledge, power and culture, now in ruins, satisfy the curious gaze 
of travelers. The former grandeur of Spain, the richness of historic 
lore and works of art, could not save her from the humility of recent, 
•crushing defeat. 

The ancient monarchy of Great Britain has lived to see the young 
republic of the United States become her rival in wealth and power. 

m 

Populous cities and thriving towns mark the spots in our own 
•country, where, but a few decades ago, savages roamed at will. 

With each successive change in*national life are evolved new laws, 
new customs and new environments for the individual. The evolution 
•of individual character necessarily wrought by national development, 
4)rings us as physicians face to face with new diseases and new phases 
of disease. This fact is typically exemplified in the results of the 
strenuous life of modern times. 

The mad rush for wealth and position and the ever increasing 
rivalry in business and social affairs results in disorders so well'known 
• to us, affecting principally the nervous and cardio-vascular system. 
That phase of the strenuous life occuring in school children is the 
subject proper of this paper. The increasing demands upon the adult 
to meet the requirements of the times, call for a keener and more 
varied training in the formative period of life and the child is thus 
■compelled to endure a burden relatively quite as heavy as that to be 
imposed in after years. 

No further proof of this is necessary than a glance at the prescribed 
<:ourse of study in most of the public schools, and the requirements 
for entrance to the best colleges, and a comparison of these to the 
time usually allotted to such a course. For the average student to 
accomplish this task in a thorough manner and suffer no physical or 
mental consequence is almost an impossibility. The constant strain 



132 MEDICAL SOCIETY OF NEW JERSEY. 

to achieve the impossible, accompanied as it usually is, by threats and 
fear of failure, not only precludes any sort of mental discipline or 
development but, on the contrary, results in physical, and perhaps, 
also, mental deterioration. It is constantly administering an un- 
merited punishment in schools and colleges far more disastrous and 
much more cruel, though apparently more refined, than the rod which 
was abandoned long ago. 

Before determining the amount of mental work which can, with 
safety and propriety.'be required of a child, there are certain well- 
known and generally accepted facts which should be considered. 

The delicacy of the nervous system in childhood and its readiness 
to respond to reflex disturbances, depends upon clearly determined 
anatomical and physiological facts. As pointed out by Gowers, at 
the time of birth, only parts of the cerebro-spinal system are struct- 
ually complete. Extensive tracts of fibers have not yet acquired their 
white medullary substance, and until the axis-cylinders are thus 
clothed, the fibers have but little conducting power. The lower 
centers are further advanced than the higher and are in consequence, 
imperfectly controlled. According to Jakob, meduUation begins 
during the fifth foetal month, and is not complete until adult life. 

The relative size of the brain as compared to the other organs, is 
much larger during the period of growth than in the adult and does 
not assume a fixed relation to these organs until the eighteenth or 
twentieth year. 

During the period of rapid growth less mental work can be safely 
required of children than when growth is completed or less rapid. 

That children are easily fatigued has been demonstrated by certain 
physiological experiments upon their mental processes. According to 
Dr. Robert Lovett. of Boston, " it was found that there was an 
increase of thirty-three per cent, in mistakes in dictation tests given 
early in the morning, and after a few hours of study and recitation. 
In pupils from twelve to thirteen years of age, it was found that there 
was a markedly lessened ability to apply themselves after the third 
quarter of an hour of continuous work. Taking five hours of inter- 
rupted work, such as the ordinary school routine furnishes, it was 
found, in a ten minute test taken every succeeding hour, that the 
amount of work increased up to the third and fourth hour, but dimin- 
ished in the fourth or fifth, and that the number of pupils making no 
mistakes decreased from the first to the fifth hour." 



PRESENT METHODS OF EDUCATION. 1 33 

Ignatieff found that 191 out of 243 children lost on the average of 
2^2 pounds during the examination period. 

Christopher, in tests made in schools in Chicago, established the 
fact that endurance decreases toward noon, increases again after the 
noon hour and diminishes again toward night. 

• Another well established fact is, that recovery from mental fatigue 
is much slower than from physical fatigue, and yet the working hours 
of school children, taking into account the amount of study done at 
home, approximate very closely the legal working day of the ordinary 
laborer. There is, also, during the period of development and rapid 
growth, a diminution in the. power to resist fatigue, either physical or 
mental. Not only is resistance to fatigue lessened by over-work in 
schools but the same holds true of resistance to disease. It is claimed 
by competent observers that chronic disorders are more frequent 
among children who attend school during the whole day than those 
who go in the morning only. It has also been found that acute 
diseases are more prevalent during the examination period, when 
fatigue is greatest and resisting power the least. The vast difference 
existing in school children, as they are ordinarily brought together, 
not only in physical strength snd development but also in mental 
capacity, is a most impressive fact. And, yet, all degrees of bodily 
perfection or imperfection and of mental capabilities are subjected to 
the same standard of requirements. 

The individual is lost sight of and the cruel law of survival of the 
fittest works sad havoc with those who for any cause are lacking in 
physical or mental vigor. The element of sex is also completely 
ignored and the delicate girl at one of the most critical periods of 
her life is forced to endure a strain wholly incompatible with her 
physical resources. Disorders of the nervous system are probably the 
most common results of the high pressure and disregard of physical 
laws in our school system, but the special organs and viscera suffer in 
no small degree. The effect of nerve tension as a predisposing cause 
of visceral disease is being constantly more fully recognized. 

A prolonged high arterial tension is likely to result sooner or later 
in changes in the internal organs. Especially, is this true, of some 
of the various kidney lesions. It is no uncommon thing for a person 
of good habits, guilty of no excess in eating or drinking to become the 
victim of kidney trouble, brought about solely by the mental strain of 
work and worry. That the tension of school life can predispose to 



134 MEDICAL 'SOCIETY OF NEW JERSEY. 

such a condition, if not actually cause it, is by no means improbable* 

Menstrual disorders are especially common in young women in 
school. Dr. Jane Kelly Sabine, of Boston, in observation of 2000 
young college girls, found such troubles to exist in seventy-five per 
cent, of them. 

Various forms of eye trouble, especially errors of refraction, are so- 
commonly found that crude examinations of eyes by means of test- 
types are systematically made by the teachers in certain schools. 
This, I understand, has been recently done in the public schools of 
Philadelphia. 

Defects in speech and hearing, gastric and cardiac disturbances* 
spinal curvature and imperfect lung development go unrecognized 
and are aggravated by the conditions and environments of school life. 
That tuberculosis is often unwittingly communicated in this manner 
needs no demonstration in the light of our present knowledge of the 
bacillus tuberculosis and its method of propagation. 

But the body does not alone suffer, for in the thoughtless haste to- 
cram the young brain full of facts, the memory is over-taxed and the 
mental discipline, the judgment, the power of logical and deliberate 
reasoning are lost sight of entirely. Before an attempt is made at 
cure, an accurate diagnosis is necessary, and, before remedies are 
applied to the educational system, the exact factors responsible for 
the existing conditions, should be definitely understood. The most 
apparent of these factors seem to be : 

1st. A multiplicity of studies. 

This is a natural outgrowth of the material tendency of the times. 
A consideration of the branches to be taught, involves an under- 
standing of the real objects of preliminary education. From the 
simple idea of mental discipline or mental gymnastics which prevailed 
among the Greeks and Romans and the monastic schools of the 
middle ages, the practical view of education has been gradually 
developed, which considers the acquisition of facts rather than the 
discipline of the mind as the real object in view. 

That the penduluni has swung too far and that mental discipline^ 
rather than memorizing of facts, is of the first and most vital im- 
portance, is voiced by many authorities on educational matters and by 
many profound thinkers. 

2d. The baneful effect of examinations. 

The mental worry and physical torture resulting from the system 



PRESENT METHODS OF EDUCATION. 1 35 

of ejcaminations as well as their inadequacy as a test of standing, is so 
well understood by teachers themselves that they are being abandoned 
in many schools, where a proper average of daily work has been 
maintained by the student. That great educator and finished scholar, 
Prof. Hiram Corson, of Cornell University, speaks as follows on the 
subject : •* Examinations are the bane of literary study. * * * 
I have been present at literary examinations which brought out 
answers, acceptable, indeed, to the examiners, but, which, no more 
evidenced the students' knowledge of the works on which they were 
examined than the boy Bitzer's definition of a horse, in the second 
chapter of Dickens' 'Hard Times,' evidenced that he knew anything 
of the noble animal he defined, though it was entirely satisfactory to 
Thomas Gradgrind, the examiner on the occasion, who believed, that 
facts alone are wanted in life." 

The definition was as follows : 

"Quadruped. Gramnivorous. Forty teeth, namely, twenty-four 
grinders, four eye-teeth, and twelve incisive. Sheds coat in the spring ; 
in marshy countries, sheds hoofs, too. Hoof hard, but requiring to be 
shod with iron. Age known by marks in mouth." 

If the present methods of examination could be entirely abolished 
and the incentive of conscientious daily work substituted, it would be 
another step in advance. 

3d. The imperfect classification of scholars both as regards physi- 
cal condition and mental aptitude. 

Not only should the exact physical condition of every scholar be 
determined and the proper remedies applied, but also should a classi- 
fication be made on a psychological basis. This would prevent much 
of the evil arising from the association of children of different abili- 
ties, and would preclude the possibility of having those in public 
schools who should properly be in institutions for the feeble minded. 

This could only be accomplished by a frequent and thorough exam- 
ination of all school children by competent physicians. A beginning 
has been made on this line in this State, in the cities of Orange, 
Plaintield and Camden, and, as far as I am able to learn, with very 
satisfactory results. 

While the three causes which I have enumerated, viz : The multi- 
plicity of studies ; the system of examinations, and the lack of classi- 
fication of scholars, are most responsible for the defects in the present 
school system, there are many more which might have been alluded 



136 MEDICAL SOCIETY OF NEW JERSEY. 

to if time permitted. School hygiene, the establishment of a depart- 
ment of physical education, and the development of vital statistics as 
relating to school population, are especially worthy of consideration. 

The medical profession has a duty to perform in regard to the 
health and well being of school children. It is a question which deeply 
interests us both as men and physicians. As men and good citizens it 
is our desire to see the youth of our land grow up into well rounded 
men and women, developed into the fullest and soundest mental, 
moral and physical life possible. As men we may be even touched 
by a more tender interest ; for I doubt not there is more than one in 
this audience who has seen a son or daughter, a brother or sister, fall 
by the wayside, a physical wreck, a victim of nerve-strain, while in 
school. 

As physicians the subject is of interest to us as affecting the well 
being not only of the present generation tut, through heredity, of 
future generations as well. In many ways we can let our influence 
be felt in this matter, by awakening a deeper interest among teachers 
and parents, by having, as far as possible, a competent representative 
of our profession upon boards of education, by influencing legislation, 
and by its more frequent discussion in representative medical bodies. 

I appeal to you, therefore, not only as men and physicians, to give 
the subject your earnest consideration, but also, as members of this 
honorable body, the Medical Society of New Jersey, ever alert in rec- 
ognizing wrong, ever ready to correct it. 

DISCUSSION. 

Dr. R. C. Newton, Montclair. — The paper which has just been 
read before us touches probably the most important question of our 
modern civilization. It is utterly impossible to thoroughly discuss 
this subject in any one of our sessions, and I can only touch on one 
or two of the important points so well brought out in the paper. 

I have always felt that our entire educational system is defective in 
that there is too little individualization. The very bright should not 
be held back, nor the very dull dragged along too rapidly, so that the 
school as a whole may advance uniformly. This Procrustean method 
of education may, and often does, result in as much mental damage to 
the pupils as the being placed on the famous bed of the old freebooter 
either abridged or elongated injuriously the corporal frame of his vic- 
tims. In short, Procrustes might be said to have been a person whose 
ruling passion was uniformity. 



PRESENT METHODS OF EDUCATION. 1 37 

There is, however, one point upon which Dr. Tomlinson has not 
touched, namley. the foolish desire to excel one's companions which is 
"fastened in parents and children alike by competitive marking and by 
tprizes and rewards for surpassing others. So far as advancing the pupils 
too rapidly, teachers have told -me that they were frequently willing and 
anxious to keep certain pupils back, but that their advance to a higher 
grade has been urged, even insisted upon, by the parents. A very 
•learned friend of mine once said to me, that in the last analysis, human 
vanity is the mainspring of human action. Whether this be so or 
'not, vanity and the appeal to the vanity of scholars and their parents 
and friends is one of the principal causes of the nervous breakdown of 
so many of our girls. By the natural peculiarity of the female mind, 
♦there is a great development of the mental powers of the young 
-woman commensurate with the period of her highest physical develop- 
ment. This is true in a measure with boys, who show an increased 
mental aptitude as they reach the age of puberty. There is, however, 
the important difference that the boy's development into a man is 
•blower than that of the girl into womanhood, and his nervous system 
is less disturbed than his sister's, nor is the drain upon his physical 
fpowers so severe at the age of puberty as is that of the girls. 

Undoubtedly, as pointed out years ago by Madison Taylor, girls in 
^schools are more liable to scoliosis, indigestion, headache, and all the 
train of evils which we find amongst them, because rheir muscular 
and nervous systems are less developed by exercise and out-of-door 
4ife in their younger years than boys. A girl not only inherits a feebler 
body than a boy, but her dress, her training and her entire environment 
tend to keep her feebler. Little girls particularly should receive especial 
physical training from birth. They should get much fresh air and 
actual hard physical exercise. The dress of even little girls is 
much against their proper development. So that they acquire little 
reserve strength. The absurd custom of discouraging them from 
•outdoor sports and keeping them prettily dressed and preventing 
them from rational enjoyment because they may soil their garments, 
has much to do with their unstable nervous systems and constipated 
bowels in after life. 

• Woman is the weaker vessel, and she always will be, but her dress, 

habits and mental attitude must change before she will have an even 

chance in the educational rush of the present day. I have spoken 

-chiefly of girls because the mental breakdowns from overwork in 



138 MEDICAL SOCIETY OF NEW JERSEY 

school are. so far as my observation goes, almost entirely confined to 
girls. As Professor Pierce, of Philadelphia, once told me. the teeth 
of the high school girls in his town always showed by their deterio- 
rated condition the strain of the examinations, while the teeth of the- 
boys, owing to base-ball and out-of-door life, suffered no especia) 
damage at examination time. This, to my mind, shows the nervous 
strain under which high school girls labor, even more strongly thaiv 
their menstrual irregularities. They are always just ready to break 
down, just as Dr. Tomlinson has so well shown. They are so con- 
stantly overworked and overwrought that they have lost their nervous 
resiliency and that excess of vigor over and above the actual daily 
drain which is necessary for good work as well as for good health. 

As Lysander said of old, ** The hope of a nation's prosperity is in the 
bodies of its women." Either the present educational strain must be 
abated or girls must be more systematically trained for it. They must 
dress, live, eat and think differently from what they do now. We must 
either relinquish the idea of giving a woman a man's book learnings 
or we must revise her physical education from infancy, giving her the 
same out-of-door muscle-begetting and nerve-strengthening life which 
the bov has, and which fits him to stand the strain -of the school so 
much better than his sister. Whether this shall prove an unmitigated 
blessing or not is doubtful ; whether nature did not mean women to 
be more indolent, more reposeful, more intermittent in their efforts 
than men, it is hard to say. Except while brooding and caring for 
her young, the female animal seems as capable of continued severe 
exertion as the male. 

The point I wish to insist upon is, if women are to do men's work, 
more radical changes must be made in their entire mode of life thai* 
medical supervision of their school courses. Their education for the 
strenuous life must begin at birth, and be systematically pursued.. 
Corsets, high heels and all such crimes against development and 
common sense must be banished forever. 

Dr. W. B. Johnson, Paterson. — The subject of school hygiene is 
both old and new. It is old because the things which seem to have 
been paramount have been accomplished ; it is new because the things 
which are now paramount were not thought of when the question, 
originally came up. The question is. what improvement have we had 
in the hygienic conditions ? The improvement has been great. We 
have now school houses which are properly lighted and ventilated,: 



PRESENT METHODS OF EDUCATION. 1 39 

a,nd properly furnished ; they are so furnished that the seating con- 
ditions are conducive to the best interest of the pupils. We have at- 
tention to calisthenic exercises, and to recesses and all of the things 
which would seem to have been necessary when the question was 
originally opened. But our desires have not been accomplished, and 
the predicament we now stand in is this. With all these increased* 
facilities our children are under a stronger strain than formerly, and 
are living a more strenuous school life than when we began the agi- 
tation of the hygiene of the schools. This is the result of the unfor- 
tunate advantage, I was about to say, that the educators have taken 
of the conditions we have established. The educator has what might 
be called a limited range of accommodation in this direction. He sees 
nothing but the importance and the necessity of pushing onward and 
upjvard whether the children can stand it or not. We fixed it so that 
the conditions of the schools were such that ordinary children could 
stand the amount of study which seemed to be necessary at the time 
we started on our reform ; now the educator has pushed the require- 
ments past this point, and as a result, the children are under more 
strain than ever before. The curriculum of the high schools has been 
increased, and the curriculum of the college entrance examination has 
been tremendously increased. When I went for examination for ad- 
mission to the university, I stayed about a quarter of an hour with 
each examiner, going in turn to several professors, and after running 
the examination from nine o'clock in the morning to four in the 
afternoon, had passed. A year or two ago my daughter tried this 
examination. It lasted from Monday until Saturday, each examin- 
ation being two hours and a half long, and it entailed a great deal of 
writing. The college requirements seem to me to have been pushed 
far in advance of what they used to be. There is, in any case, a great 
deal of difference between the old method of examination and the 
present one, taking a whole week. I must say, however, that after 
getting into college, the physical condition of the girls seems ta 
improve. The strain of preparation is over and the college course 
itself seems more nearly adjusted to the ability of the student than 
that of the preparatory school. The educator must acknowledge^ 
however, that the clientele of the college is really selected scholars, 
since the average falling from the ranks, for various reasons, during 
the college course is about fifty per cent. 

Dr. DowLiXG Benjamin, Camden.— I have noticed that chorea 



f40 MEDICAL SOCIETV OF NEW JERSEY. 

and other decided nervous manifestations, which we frequently see in 
children, are far more frequently observed after the promotions in the 
public schools. The trouble wiih the children in the public schools is 
largely due to faulty grading. To illustrate what I mean, let me say, 
that a child will go through one room with part of an arithmetic or a 
grammar, and then on coming to the next room will be placed 
(skipped) farther along in the same book, or will be given a different 
book, in which the language and methods are different ; hence in the 
first few weeks after promotion the children have bad records. It 
should be no more difficult for a child to go from one room or grade 
to another than from one day to another in the same room or grade. 
There is need for great reform in this direction and in the matter of 
the uniformity of text books and the methods employed in these books. 
Now, in the City of Camden, we have attempted medical inspection, 
but it is so arranged there that the medical inspector does not inspect 
the pupils with regard to disease, the diagnosis being left to the 
teachers. As physicians we know that diagnosis is not the easiest 
part of our work, and hence it is defective to make the school teacher 
the diagnostician. This subject of the medical inspection of schools 
is a large one, but there is not time to consider it now. 

Dr. E. J. Ill, Newark. — We have heard of the public schools only. 
\ wish to remind you that in one of the prominent medical schools in 
New York four students committed suicide, three of them believing it 
to be impossible to pass their examination. Another student became 
mentally deranged during his studies, although he was a graduate of 
a prominent college in this country and well fitted for the work. The 
standard of education in the medical schools is being made too high, 
so that it seems almost impossible to reach it. No foreign country is 
so foolish as to over-educate the pupils as we are doing at the present 
day. Let us begin at the colleges and universities and the public 
schools will soon find their proper level. 

Dr. David C. English, New Brunswick. — I do not rise to discuss 
this question, but merely to call attention to the tremendous import- 
ance of this question treated of in the paper now under discussion* 
I think it would be wise for the Medical Society of New Jersey to 
appoint a committee to discuss this whole matter. We have seen 
what good results have followed in previous years in the matter of 
medical inspection of our schools. It has wrought wonders already. 
•. Dr. T. J. Smith. — In secanding the motion of Dr. English, I de- 



PRESENT METHODS OF EDUCATION. I4I 

sire to say a word. I believe we are making an effort in the right 
direction. No doubt everyone present was satisfied of the importance 
of this <)uestion before hearing this paper. We are all convinced that 
the facts brought out here this morning are true, and that this is a 
question which calls for the attention of somebody who may have an 
interest in probing it. We are too apt to allow sentiment to control 
the question too much. Sentiment is well enough, but it is apt to set 
too fast a pace and to get beyond our control. Now, what is the best 
and most practical way ? It is a fact that the way degeneracy is pro- 
gressing at this day is enough to frighten us ; it is spreading through 
our country and other countries at a tremendously rapid rate. The 
State is paying too much attention now to the taking care of the de- 
pendent classes, and is not giving sufficient attention to the prevention 
of men and women from becoming degenerates. We are spending 
immense sums of money for the care of the charitable institutions of 
•.his State. Not that I wish the wards of the State to be poorly cared 
for, but I believe this can be done with much less expense. The idea 
of its being necessary to take care of them in the present extravagant 
manner is all wrong, and we can house them at much less cost. The 
State has ever been ready to hear from this Society, representing as 
it does the medical profession in New Jersey, upon all questions con- 
cerning the public welfare, as we have seen from time to time. Our 
State charitable institutions have been established through the sup- 
port and encouragement of this Society. The legislature is ever 
ready to receive suggestions from the representatives of our profession. 
This motion of Dr. English brings this to a practical issue, and I hope 
it will prevail. I believe that every public school should have a medi- 
cal attendant, just as other State institutions have, and that the grad- 
ing and management of the scholars should be under the control of 
the medical attendant. 

Dr. J. Howard Pugh, Burlington.— We have been talking about 
the defects of our educational system, but we have at the same time 
passed a law for the examination of medical students. We discourage 
examinations in one direction and encourage them in another. The 
matter has been brought to my mind recently in the case of a young 
man, a graduate of Princeton College, a naturally bright and gifted 
fellow, who studied medicine in Baltimore, graduated from the Johns 
Hopkins University, and is now ready to practice medicine. He is 
much better prepared than in the days when I graduated. He can 
not practice medicine in this State without passing before our Board of 



142 MEDICAL SOCIETY OF NEW JERSEY. 

Examiners. He, therefore, proposes to take an examination before the 
Board of Examiners of New York State, whose certificate, under exist'- 
ing conditions, will enable him to practice not only in New York but 
in New Jersey, and possibly other States. I notice that it is the 
intention of the State Boards to raise theirstandards, the colleges not 
having a sufficiently high standard, and yet while subjecting medical 
students and graduates to all these tests, we are deprecating the 
strain put upon pupils in our public schools and other educational 
institutions. 

Dr. Cornelius Shepherd, Trenton. — To undertake to discuss a 
question of such profound importance in five minutes is utterly impos- 
sible. There is not one present but is thoroughly impressed with the 
importance of this topic. During the forty years I have been con- 
nected with this Society, there has always been the same interest in 
■education and every cause which promotes the interests and advance- 
ment of human beings. During my lifetime I have been fortunately 
connected with the public schools of this State for nearly twenty 
years, and during this time I have obser\'ed and considered these 
important questions that have come before us. If this committee, no 
matter how constituted, is able during the coming year to devise any 
plan by which our schools can be placed in better condition, we shall 
all be heartily in favor of it, but the very beginning of this movement 
must be in the family itself. To-day the children are brought into 
the world in an enfeebled condition. This is the first thing for the 
committee to consider. When you come to classify and educate all 
•classes you will be confronted with one of the most difficult of prob- 
lems that can be presented. Children are not all alike in both physical 
and mental capacity, and to undertake to educate tliem together is, 
of course, wrong. Our children go to school under different circum- 
stances from those formerly existing. Some children must depend 
upon their own exertions, having no one to assist them at home ; 
others come with their lessons well prepared, not because of their 
superior ability, but because they have been ably assisted by those at 
home. The poor girl and boy who have labored night after night 
unaided, because the lessons are not perfect, are kept back and not 
promoted. We must, therefore, see that every one who is elected to 
manage the schools, and every teacher selected, thoroughly under- 
stands and enforces these questions. They are the ones you must 
hold responsible. Medical inspection of the schools cannot accom- 
plish this. 



REPORT OF COMMITTEE ON LEGISLATION. I43 

Dr. Charles D. Bennett, Newark.— 1 wish to add a few words 
on this subject of over-education. The trouble is the general tend- 
ency of modern limes to subordinate the physical to the mental. The 
^ody is weakened and exhausted in order that the brain may take a 
more prominent part. The grade of our colleges, the time of en- 
trance, and the lengthening of the courses and making them more 
<lifficult are factors in producing this. The mind of the growing 
child cannot accomplish it all. Some educators appreciate this, and 
it is here that we must endeavor to introduce the reform. It is a 
difficult problem, because, for example, it is the physician's brain as 
•compared with his body that gives him prominence in the community 
^nd his work. 



Report of Committee on Legislation. 

To the Medical Society of New Jersey : 

Your Committee on Legislation beg leave to make the following 
report : 

We feel that medical men in the past have been negligent of their 
-duties political, and the time has certainly arrived when we, as a 
State organization, should be cognizant and take an active interest in 
all matters coming before the legislature of a medical or sanitary 
•nature. We feel that legislative organization in the national body, as 
well as in the State societies, in the future, must be universally 
tangent so that it will be possible, whenever necessary, to have the 
hearty co-operation of one or all of the State and territory medical 
-societies through their legislative committees in any and all medical 
matters pending in either the national congress or in the State legisla- 
tures. This plan is equally applicable to each district society, and if 
there is hearty co-operation of all, much may be accomplished. This 
was readily shown in the efforts of your committee on the sanitorium 
for tuberculosis patients, as our first effort made two years ago, was a 
•dismal failure. After having the hearty co-operation of the several 
-district societies we were able to accomplish very much more this past 
winter, from the fact that the members of the legislature, almost 
universally, seemed to be well informed of the intent of the bill. 

Dr. Strock's essay read before the Society one year ago, "A Plea 
ior the Physician on the Witness Stand," was referred to this Com- 
mittee for action, and, after consultation with Dr. Strock, your Com- 
mittee approve of the memorandum presented by him as to proposed 



144 MEDICAL SOCIETY OF NEW JERSEY. 

legislation and suggest that the Committee on Legislation be in- 
structed to draft and pass a bill at the next session of the legislature; 
covering the provisions of this memorandum. 

No person duly authorized to practice physic or surgery shall be 
allowed to disclose any itiformation which he may have acquired in> 
attending any patient in his professional character, and which was 
necessary to enable him to prescribe for such patient as a physician, 
or to do any act for him as a surgeon. 

Provided, the provisions of this statute may be waived by the 
patient at time of trial or examination. And provided, further, in 
case of death or insanity of the patient, such waiver must be made by 
the personal representative of the patient. 

We further approve of the resolution as presented to the Society 
by Dr. Marvel that the Committee on Legislation be requested to- 
ascertain through the secretaries of the several county societies and 
otherwise, as it seems proper, the number of practicing physicians in 
the several counties who are not members of their county society 
and, also, of the number of illegal practitioners of said county and 
report the same at the next annual meeting. We recommend that 
you empower the chairman of the Committee on Legislation to obtaii> 
the information called for in this resolution. We further suggest 
that you authorize this Committee to take the necessary measures ta 
prevent any legislation looking to the recognition of irregular practi- 
tioners. We further suggest, that as there is no law in this State on 
the subject of fees for examination of indigent insane patients for 
commitment to State hospitals, and for making post-mortem exam- 
inations ordered by the coroner, that the chairman of the Committee 
be empowered to put in legal form for presentation to the Society at 
its next annual meeting, a bill covering this question, and that the 
Committee request members of the State Society to communicate 
their opinions on this matter to the chairman. 

We would respectfully ask that the Secretary of the State Society 
notify the the chairmen of the various committees of their appoint- 
ment thereto within sixty days after the annual meeting. All of 
which is respectfully submitted. 

L. M. Halsey, Chairman, 
J. L. Leal. 
J. D. McGiLL. 
E. L. B. Godfrey. 



valvotomy. — obstinate constipation. i45 

Valvotomy as a Surgical Measure for the Cure 

OF Obstinate Constipation. 

BY WILLIAM M. BEACH, A.M., M.D., PITTSBURG, PA. 

A new medical theory must stand the test of clinical experience for a 
period, to determine its acceptance or rejection by the profession. The 
inquiring and conservative medical mind is every ready to search and 
welcome truth, and needs only the bedside evidence to be convinced' 
of its essence. Truth is eternal, and little by little do we extract it 
from the realm of the great unknown ; nor is it heralded by trumpet" 
sound and triumphal march, but quietly reveals itself in the clinical 
and experimental laboratories. 

The historical evolution of our noble science affords many examples 
of conservatism which subsequently became the universal rule of 
practice. The profession looked with wonder and astonishment upon 
McDowell's laparotomy, and not for several year6 afterward was this 
pioneer's achievement recognized as one of the milestones in the 
progress of surgery. Jules Lamaire. and later, Sir Joseph Lister, 
taught the essentials of antiseptic surgery, and not for years after 
its promulgation was it accepted as a great truth. And thus we may 
'mention anaesthesia, the thermometer, hypodermatic medication, vac- 
<:ination, serum therapy and the Roentgen ray. All these advance- 
ments had their enthusiastic devotees, as well as doubting Thomases, 
in the medical profession, but are now established beyond peradven- 
ture. 

The field of rectal surgery is receiving the consideration its import»- 
ance demands. Marked advances have been made by such investigat- 
ors as Mathews, AUingham and Bodenhamer, and more recently by 
Martin, Cooke and Heath. The proctoscope has revealed new data 
in rectal pathology, and has enlarged our conception of rectal disease 
as a causive factor in the production of obstipation and various refiexes. 
I regard the study of the new theory of obstipation depending upon 
hypertrophied rectal valves as a distinct advance, and one that has 
proven to be practical While yet in the experimental stage, I believe, 
when more is known of the mechanic principles involved and the 
•clinical results obtained, that it will be generally accepted as rational 
practice. 

The basis of this communication consists of a consideration of the 
rectal valve in its relation to obstipation and the operation devised to 
10 



146 MEDICAL SOCIETY OF NEW JERSEY. 

remove the obstruction. By inference, obstipation may be defined as 
the inabihty to evacuate the bowels by virtue of intra-rectal obstruc- 
tion of valvular origin. In this connection three thoughts are sug- 
gested : 

1. The rectal valve is always present. 

2. It is a definite anatomic structure. 

3. It may become pathologic and, therefore, obstructive. 

One who is accustomed to the routine practice of proctoscopy invar- 
iably observes the folds described by Houston, usually three in num- 
ber, dividing the rectum into as many chambers. All observers admit 
their existence, but some differ as to their nature and function. The 
number of valves varies. I have observed six. I believe similar ob- 
servation has been made by Martin, whose research has brought this 
matter before the profession, as well as by Earle, Tuttle, Cooke, 
Pennington and others. We must depend upon the evidence of these 
gentlemen to prove the existence of the valve, inasmuch as they testify 
from daily observation. 

This leads us to the second item, that the rectal valve is a definite 
anatomic structure. Many who admit the presence of crescentic folds 
deny that they possess the elements of a valve. Of such, we may 
mention Mathews, Bodenhamer and others. Many are conservative 
and await further clinical evidence to convince them. It matters little, 
it seems to me, what we call these structures, since the question 
before us is to determine them as obstructive elements in normal 
intestinal functions, it is well known how difficult it is in certain 
cases to inject a quantity of water, and how much pain is thus pro- 
duced in the rectum. It is due to the effort to pass the valve straits. 
The fluid is, furthermore, retained in situ by the refusal of these struc- 
tures to let it pass — a common function of a valve. This can be 
readily demonstrated through the proctoscope by bailing out quanti- 
ties of fluid previously injected. 

A second evidence that the rectal valve is anatomic is derived from 
the cadaver who had in life suffered from obstinate constipation, 
showing these structures in situ. 

Third, the histologic evidence is conclusive that the valve is an 
auxiliary structure in the rectum. The microscope reveals a basic 
fibrous tissue separating toward the base into two layers, and becoming 
continuous with the gut wall ; it contains muscular striae, and terminates 
into a free tendinous margin. This is covered with a mucous mem- 



VALVOTOMY.— OBSTINATE CONSTIPATION. I47 

brane and it is very vascular. When the incision passes through the 
free margin, the fibro-muscular band retracts, and at the base of the 
wound the planes separate. 

Fourth, the physiologic evidence of the rectal valve in man is its 
function to support the fecal column in the upright position and pre- 
vent precipitate defecation. 

Fifth, the clinical evidence consists of unrequited efforts to evacuate 
the bowels even when aided by physic and injections. 

This leads me to my third proposition : The rectal valve, though 
anatomic, may become pathologic and, therefore, obstructive. In 
observing the cavity of the rectum with thickened valves, one cannot 
fail to note the rigidity and inelasticity of these bands that span two- 
thirds the calibre as they jump across the view when relieved by the 
withdrawal of the proctoscope. The lower or first valve is at right 
angles with the gut axis, while the second and third are obliquely 
placed ; so it is evident that the first may be more obstructive. Hyper- 
trophy of the valve is usually accompanied hy rectitis and colitis of the 
catarrhal form. These cases, as a rule, give a history of dysentery^ 
when lymph exudate contributes to the narrowing of the calibre, or 
the atresia may be congenital. I have frequently observed procidentia 
of the sigmoid into the rectum, the result of severe straining at stool, 
becoming a source of constant irritation to the recto-sigmoid strait. 
In a paper read at the American Proctologic Society, I stated that 
recto-colitis due to sigmoid procidentia is the source of more reflexes 
and more difficult to cure than any other rectal disease. Obviously 
the primary trouble consisted of obstruction below that point in a 
stiff valve. 

In this connection I would state some of the symptoms of obstipa- 
tion. They are: i. Local. 2. Systemic. 

The local symptoms consist of a desire for stool but inability to 
secure it with ease ; repeated efforts at straining have little effect, and 
he will refer the point of obstruction just inside the anal rectum. His 
efforts sometimes will be rewarded by passing part of an injection 
used to facilitate a movement and a few small broken pieces with 
mucus. He has pain in the abdomen and a sense of fullness and 
hardness due to pent-up gas and feces, and will state that his abdomen 
feels as if a stone were there. 

The systemic symptoms are the result of auto-intoxication, a 
product of coprostasis, and manifests itself in the variableness of. 



148 * MEDICAL SOCIETY OF NEW JERSEY. 

neurasthenia, multiple reflexes, as dyspepsia, headache, backache, 
urethral and bladder irritation, insomnia, cold extremities, nervous, 
irritable and despondent. The sexes seem alike amenable, but I have 
observed the most marked forms in the male of sedentary habits. 

Treatment. — From the foregoing, it would appear, that in certain 
cases of obstipation the patient cannot secure desired relief from 
medical measures, but must be consigned to the surgeon for results. 
And, as in all surgical procedures, the rarest judgment is necessary to 
determine when the valve should be reduced by cutting, or whether 
massage will overcome the obstruction. I am considering only the 
rectal valve as obstructive, since it is well-known how many other 
ctiologic factors must be eliminated, such as retroverted uterus, pelvic 
growth and adhesions, ileus, intussuception, angulations and malig- 
nant disease. 

Having selected a proper case, I shall now describe the operation 
known as 

VALVOTOMY. 

There is a general impression that the simple divulsion of the 
sphincter ani will cure or benefit obstipation, but a trial is sufficient 
to convince the surgeon of its inadequacy. 

Valvotomy, properly performed, will invariably overcome the obsti- 
pation and generally cure the constipation habit. The technique is 
simple enough, but it requires a great deal of practice to become 
skilled in the operation. The instruments needed consist of procto- 
scopes of graded lengths for each valve to be treated, a test hook to 
determine the depth of the valves, two tenacula to secure position of 
valve, a valvotomy knife, a curved needle and shot compressor, and 
an illuminating apparatus. 

The patient is placed in the knee chest position. A four-inch proc- 
toscope, one and one-fifth inch calibre, is inserted, the rectum 
ballooned, when the valves are brought to view. The selected valve 
is sprayed with a one per cent, solution of eucaine, followed by 
mopping its surface with a concentrated solution of supra-renal 
capsule. The test hook determines the point of safety and depth at 
which the structure may be incised. Then the tenacula are placed, 
and, while the proctoscope is held by an assistant, the division is 
made by the valvotomy knife. Two incisions are made on each valve 
by transfixing and cutting out through the tendinous margin. A 
gunshot suture is now placed in the angle of the gaping wounds, and 



VALVOTOMY. — OBSTINATE CONSTIPATION. ' 1^9 

one on either side, for the purpose of bringing together the cut 
margins of mucous membrane, thus avoiding a large granulating 
area and a possible peritonitis. A flap door is formed by this oper- 
ation, and the strong, fibrous biand retracts, bringing to view the 
second valve which was obscured by the first. The operation is 
continued as before until the lumen is patulous and free from ob- 
struction. The chambers are packed with styptic wool tampons, 
placed so as to insure mechanic as well as chemic force on the 
bleeding points. 
The dangers are two-fold : 

1. Hemorrhage. 

2. Peritonitis. 

The tissues to be divided are very vascular, and the* operator must 
use every precaution to control the bleeding. My plan is to brush 
the eucanized surface freely with solution of supra-renal capsule prior 
to cutting, then follow with tamponage. 

Peritonitis is certain to follow an opening into the peritoneal cavity, 
if not repaired at once. It requires the rarest surgical judgment to 
determine the depth of the incision, which, if not deep enough will 
not secure the desired result. Should the accident happen that the 
incision is too deep, the suture can be placed and the perforation 
obliterated by first intention healing. The wounds heal very rapidly 
and care must be taken to retard the process by keeping the cut 
margins separated. The patient is given a daily saline arid a hot 
enema for two weeks, when he is discharged cured. 

As a practical and radical procedure, valvotomy is yet in its infancy. 
It need hardly be stated that its practice will be limited, for the most 
part, to the proctologist, since the armamentaria are specially devised 
and much time is required for the suscessful treatment of the disease. 

General anaesthesia is not required in valvotomy. 

Valvotomy will not only cure obstipation, but is the key to the 
solution of the concomitant symptoms of atony of the rectum, noc- 
turnal emissions, irritable bladder, certain forms of dyspepsia, and 
various neuroses. 

E. F., male, aet. 26, occupation, bank clerk ; family history, good ; 
nervous and irritable, dyspeptic, poorly nourished, appetite fair, poor 
sleeper, migrating pains, backache, radiating abdominal pains and a 
sense of weight in the abdomen, tired feeling, eructations of gas ; 
could not defecate without the aid of large physic supplemented by 



ISO* MEDICAL SOCIETY OF NEW JERSEY. 

enemas, and yet an unrequited stool ; the act was accompanied by 
straining, and the fecal column broken and passed in short segments 
and hard balls ; these were covered with glairy mucus ; he was unable 
to pass flatus ; and felt that if he could only get a good evacuation 
he would be so relieved. 

Dr. Thorn kindly referred the patient to me, after exhausting all the 
ordinary measures for the relief of his obstipation. Proctoscopy re- 
vealed an hypertrophic rectitis extending to the sigmoid flexure, the 
sphincter ani was lax. The column of Morgagni was swollen, the 
congestion extending to the sacculi Horneri. Above the levator ani 
and anteriorily the first rectal valve or partition was much enlarged 
and thickened, inelastic, and spanned two- thirds of the lumen. 
Pressing the proctoscope beyond, we found the second valve much 
the same. The third valve was not so bad, but shoved aside an en- 
larged sigmoid cavity was exposed. The disease was clearly one of 
obstipation with constipation, and the obstruction consisted of the 
first and second hypertrophied rectal valves. Valvotomy was per- 
formed upon these two valves in March, 1900, with the result of re- 
lieving the patient entirely of his obstipation. Six months after the 
treatment he enjoyed a daily evacuation without aid, except the oc- 
casional use of a mild laxative ; the stools were well formed and 
passed in unbroken column. This patient required a little additional 
treatment, since the reduction of the third rectal valve is needed to 
effect a complete cure. 

I have observed a number of women suffering from amenorrhoea or 
dysmenorrhcea, and irregular menstruation, apparently cured by val- 
votomy. The following case illustrates : 

Miss G., a nurse, aet. 20, had been treated by the gynaecologist for 
irregular and painful menstruation, with only temporary relief. When 
referred to me, in February, 1901, she was constipated and could not 
remember ever having a satisfactory stool, even when aided by physic 
or rectal injection. The fecal column would appafently stop at a 
a certain point, and considerable straining availed naught toward 
completing the evacuation. She would faint during such a crisis, and 
could get relief only by large injections. Auxiliary symptoms con- 
sisted of backache, post-cranial and cervical pain, heaviness of the 
thighs, a line of dyspeptic disorders, as weight in the' abdomen, flatus 
that would not pass per rectum on account of obstruction but would 
give rise to eructations, vague pelvic and abdominal pains, all of 



ETHYL-BROMID 151 

which conduced to the neurasthenic state, which rendered the patient 
irascible and irritable, unfitting her for her work. Proctoscopy un- 
folded a mechanical intra-rectal obstruction that was typic. The first 
and second valves were so stiff and swollen that by their conjoint 
action they completely shut of! the lumen when the patient would 
bear down. This valve strait would only permit small pieces or por- 
tions of fluids to pass, and would even prevent the free passage of 
gas. Beyond the second valve was found a large dilatation. Valvot- 
omy was performed on both valves, and on the second day the patient 
enjoyed a new experience to her— a free and satisfactory passage. 
Daily saline, gradually lessened in quantity, and daily injections of hot 
water for two weeks were given. When the wounds healed she was 
discharged cured, with marked amelioration of all her former symp- 
toms, and, not the least remarkable, she has menstruated regularly 
and painlessly ever since. 

DISCUSSION. 
Dr. a. K. Rogers, Paterson. — When I was a younger man I 
sometimes had to deliver the rectum before I delivered the child. It 
is not uncommon to find a loaded rectum even now, and one of the 
most important things, I think, is to teach persons to use the finger at 
times when the enema alone will not cause an evacuation of the 
bowel. 



Further Report on the Use of Ethyl-Bromid 
AS A Primary Anaesthesia to Ether. 

EMERY MARVEL, M.D., ATLANTIC CITY, N. J. 

At the last meeting of this Society, it»was my privilege to present a 
paper detailing the use of ethyl-bromid as a primary anaesthesia to 
ether or chloroform. In this procedure ethyl-bromid was adminis- 
tered until unconsciousness was obtained, at which stage of the anaes- 
thesis ethyl-bromid was withdrawn and sulfuric ether, or chloroform, 
was given to secure complete anaesthesia and maintain the anaesthetic 
state for the length of time required. 

The method was simple, and consisted in placing in the palm of the 
anaesthetizer's half-folded hand a piece of folded gauze. Upon 
this was poured a fluid dram of ethyl-bromid, which at once was 
placed in contact with the patient's nostrils. 

A few inhalations were usually sufficient to secure unconsciousness, 



152 MEDICAL SOCIETY OF NEW JERSEY. 

when ether or chloroform was immediately substituted, being admin- 
istered by the customary manner in which these agents are respect- 
ively employed. 

Thirty-six cases of anaesthesia obtained in this manner were tabu- 
lated ; in twenty-one of which ether was used, and in fifteen chloroform 
was administered as the dependable agent. The observation noted in 
the records of these cases pointed convincingly to the benefits secured 
to both patient and operator by this method over those attained when 
ether alone was used. These benefits were : A shorter time required 
to secure anaesthesia ; less discomforts to the patient in becoming anaes- 
thetized ; a smaller amount of ether required with a more rapid return 
to consciousness, and a decreased tendency to post-anaesthetic vomit- 
ing. 

Since this paper was presented my attention has been called to an 
article by Dr. George Ryerson Fowler, of New York, published in the 
New York Medical Journal, Vol. 6i, No. 17, date of April 28th,. 
1900. In this article Dr. Fowler gives the conduct in detail, as then 
observed in one patient to whom this method was applied. He writes,. 
'• From the experience gained in this case I am encouraged to make 
further trial of ethylic-bromid to produce a comfortable preliminary 
condition of anaesthesia when surgical anaesthesis is to be maintained 
with sulfuric ether." He further states that he had had an exceed- 
ingly favorable experience in upward of one hundred cases. In the 
case which was reported in full by Dr. Fowler, six drams of ethyl- 
bromid was used, but in subsequent cases but two drams were first 
used, this amount being increased subsequently if required, which was 
a rare contingency. 

I regret that at the time of compiling my previous paper I did not 
know of Dr. Fowler's article, in order that I might have been privi- 
leged to have quoted these facts. 

Since the presentation of the paper to which reference has been 
made, this method of anaesthetization has been employed by me in 
thirty-three operations. With few exceptions it has been employed 
in all operative cases for which ether was selected as the anaes- 
thetic. For reasons that seem obvious, and have been previously 
stated, I have not since used ethyl-bromid when chloroform has been 
administered. The anaesthetic has been administered by either Dr. 
Frank Katherman or Dr. W. Garrison Noe, resident physicians at the 
Atlantic City Hospital. 



SORE ARMS IN VACCINATION. ISJ 

Thirty of these cases have required celiotomies. Of the thirty- 
three, twenty were females and thirteen males, with ages ranging 
from four to seventy-six years. The time required to secure uncon- 
sciousness, varied from nine seconds to two minutes, the average 
time about twenty-five seconds. One case was not influenced by the 
agent— this was probably due to the deterioration of the drug. The 
influence upon the circulation was shown by slight acceleration of the 
heart and a mild increase in arterial tension ; that upon the respiration 
to be occasional dyspnoea with consequent cyanosis of a mild form — 
but, in one case was coughing excited. The muscular contraction 
was also manifest in some cases, but of only a moment's duration. 

The advantage of anaesthetizing by this method over that of the 
administration of ether alone are : 

The lesser time required to secure anaesthesia. 

The reduction of the discomfort to the patient taking ether shown 
in the absence of the bronchial irritation with the increased mucous 
secretions and consequent coughing. 

The diminished dangers to injury by violence from the more marked 
and longer'lasting excitation in the muscular contraction that fre- 
quently takes place in the first stage of ether nacrosis. 

The lesser amount of ether required with the consequent more 
rapid regain to consciousness, and the diminished tendency to post- 
anaesthetic vomiting. 

These advantages seem sufficient to engage our interest and invite 
the employment of a method simple in its technique and so promising 
in its good results. 



The Cause of Sore Arms in Vaccination. 

BY ALEXANDER MCALLISTER, M. D., CAMDEN, N. J. 

The past year will long be remembered for the widespread preval- 
ence of smallpox in this county. Excepting minor outbreaks in 
certain scattered centres, comparatively few cases had appeared prior 
to the close of the Spanish- American war for a period of more than 
twenty years. Vaccination was practiced only where compulsory- 
measures could be enforced, notably as in our civic school system, 
and revaccination was only exceptionally requested or even deemed 
necessary. 



154 MEDICAL SOCIETY OF NEW JERSEY. 

The contagium brought to our shores by returning troops found 
the country fairly ripe for a general epidemic of smallpox. Only 
prompt resort to vaccination and revaccination by the hundred 
thousand of our population was effective in averting a much more 
serious epidemic than that whose end we have not yet reached. 

The writer has introduced these well-known facts because of their 
important bearing upon the subject of this paper. Twenty or more 
years of growing indifference to the value and practice of vaccination 
suddenly ^terminated in the most urgent demand for vaccination. 
Never before in the world's history were so many persons vaccinated 
in so short a period of time. Physicians who had seldom found 
occasion to vaccinate for many years of active practice suddenly 
found this practice consumed a large portion of their time for weeks 
and months in succession. 

Recent highly commendable progress in the preparation of vaccine 
material and the manner in which its advantages have been heralded 
alike to the profession and the public served to raise illusfve hopes. 
The remarkable proportion of "takes" and mild character of the 
sores which the literature in question essayed to guarantee, were not 
realized in practice. In spite of the most conscientious application of 
every approved precautionary measure in the technique, a fairly large 
proportion of arms inoculated, developed intense sores and required 
from four to eight or ten weeks to heal completely. 

In the many and varied comments which these facts elicited, 
adverse criticisms were not infrequent and not a little censure was 
heaped upon the virus employed, or it may be upon the vaccinator. 

Since every practitioner has had his own trials along this line during 
the past year, it gives the writer great pleasure to present for your 
consideration a concise review of this interesting subject. 

An examination of the literature from the days of Jenner shows 
that the practice of protective inoculation has always been attended 
by certain complications. To reduce them to the minimum, the best 
talent in the profession has been engaged at all times in -an effort to 
improve the virus as well as its commercial source. 

These efforts have been fruitful of good results in many directions. 
In the substitution of bovine virus for human virus, the element of 
uncertain potency and actual danger was practically eliminated and 
the character of the possible complications very materially modified. 
This must be patent to every one who has taken the pains to inquire 



SORE ARMS IN VACCINATION. 155 

into the matter. The greatest danger to which children were once 
exposed in being vaccinated are no longer within the range of possi- 
bility. This is evident when we recall that the- children of a certain 
French village were once inoculated with syphilis in the days when 
only arm to arm vaccination was practiced. 

Certain grave complications which were once prevalent are no 
longer within the realms of probability. Indeed, the literature shows 
that in the past the complications were important and occasionally of 
•a very serious nature, in comparison with which those of to-day are 
trivial, or at most only of minor significance. The experience of our 
oldest colleagues will bear out this statement. 

The complications of the past, when human virus was employed, 
^ere syphilis, erysipelas, hospital gangrene, abscess, phlegmon, septi- 
•casmia, pyaemia, thrombosis, phlebitis, etc. Those of to-day are quite 
generally local in effect. They are chiefly embraced under the general 
term *'sore arm," and are complications, accurately speaking, of the 
•essential local lesion. Certain more or less clearly defined types may 
be recognized in the incipiency of these '* sore arms," but all will agree 
that in the end the main distinction is chiefly that of a degree of 
inflammation and the resulting destruction of tissue. 

It must be taken for granted that from the days of Jenner until now 
•certain sources of complications have continuously existed. Consid- 
'ered in what may be called the popular order of the last mind, these 
•sources are : (r) Impurity of the virus. (2) Lack of skill of the 
vaccinator. (3) Lack of proper care of the vaccine sore. (4) Pe- 
-culiar susceptibility of the vaccinated. 

On the first of these Dr. Joseph McFarland writes as follows: " In 
^pite of all the precautionary measures, it must be impossible to se- 
cure sterile pulp. Indeed, every vaccine contains three classes of 
•micro-organisms, (i) Those specific for vaccinia; (2) those nor- 
«nally living upon the skin of animals, and (3) those accidentally enter- 
ing from the dust of the stable. As a rule, all these forms are harm- 
less, but it is only those of the first class that are desirable. And 
^gain : •• The virus itself, if not properly prepared, or perhaps occa- 
rsionally through unavoidable accident, may contain infectious organ- 
isms. The most important of these are skin cocci, which occasion 
severe local lesions, and the tetanus bacillus, which has done consid- 
erable mischief of late." 

It must be remembered at this point that in every recent instance 



156 MEDICAL SOCIETY OF NEW JERSEY. 

in which tetanus complicated vaccination, the case was shown to have- 
resulted from secondary infection of the vaccine lesion and not fron> 
germs introduced with the specific virus. 

Not to pursue any further the order of the unscientific mind of the 
laity, which would lay to the charge of the physician every ill experi- 
ence in life short of the disaster of Martinique, we observe that the 
most fruitful source of excessively sore arms is the introduction of the 
skin cocci. These may be present in the virus employed, or enter the- 
wound from the patient's person at the time of inoculation, or gairv 
entrance into the sore as a secondary infection. Over the first source 
we have absolutely no control. Theoretfcally th^ glycerinized virus, 
if properly seasoned, is the purest virus to select, but can never be 
guaranteed as sterile or even free from these comparatively harmless 
skin cocci. 

The second source of these cocci is fully within the control of the 
vaccinator. The site selected for the inoculation is easily cleansed 
with proper antiseptics or mechanically with sterile water and soap. 

In these days of antiseptic surgery we may presume that generally^ 
such precautions are taken as to render this source of ** sore arms '^ 
practically ml. Should this presumption be in error, it yet remains a 
fact that there is no longer any reason why this source should be con- 
sidered a factor in the production of sore arms. 

In every instance in which this source is active there was not a. 
proper conception of the character of a protective inoculation. 

This should always be regarded as primarily an operation, and as 
such subject to the dangers of all such manipulations. To avoid sup- 
puration, as well as all other complications of wounds, cleanliness 
must be insisted upon from first to last. In the absence of this concep— 
tion of the vaccine wound, antiseptic precautions generally end with> 
the insertion of the virus, the careful placement of a shield not ex- 
cepted. 

The most carefully Shielded arms are, as a rule, the sorest. By^the 
use of shields the conditions are made more favorable both for the 
reception and growth of these cocci. 

Unfortunately, after the insertion of the specific virus, w*th all due 
antiseptic precautions, the lesion is left exposed to every source of 
secondary infection, and the added invitation of dust incidental to the 
patient's employment. The result is a large percentage of "sore 
arms." And we wonder why so few of the sores are typical of 



SORE ARMS IN VACCINATION. 157 

euncom plicated vaccinia when the subject of our astonishment should 
be that many more do not have intensely " sore arms." 

When we take into consideration the essential traumatism, the 

-character of the purest virus possible, and the indifferent treatment 

which a vaccine wound receives during a period of about a fortnight, 

^is it not miraculous that so large a percentage of vaccinations run 

uneventful courses ? 

An operative wound is kept sterile from first to last. An acci- 
dental wound is rendered aseptic as speedily as possible. In either 
case the wound is carefully treated and new dressings applied every 
two or three days. A vaccine wound is infected with specific germs 
of vaccinia and the patient sent away. Such wounds we see sub- 
sequently only when complications arise, or whfen a certificate of 
successful vaccination is the incentive to call. 

In the meantime, in addition to the causes already named, the 
patient's susceptibility to inflammatory lesions, invitations of harsh or 
filthy garments, the grave insults of little fingers, dust, incidental to 
the place of employment, unhygienic home environments, wet or 
damp place of employment, etc., etc., are patent factors causing or 
aggravating sore arms. 

The remedy lies in using pure virus, an aseptic technique, and, 
'finally, in treating the lesion as a most important case in minor 
-surgery. 

DISCUSSION. 

Dr. A. K. Rogers, Paterson. — About half of my life was spent 
■before vaccine came into use. I have observed in those vaccinated at 
schools in large numbers and with some hurry, that there is an 
unusual number of sore arms. It is important, in my opinion, that 
almost no blood be drawn during the scarification, and that the latter 
should be very small. If these precautions are observed there will 
very seldom be a sore arm. 

Dr. A. I. Hunt, Hamilton Square.— I have used the points fur- 
^nished by the different drug houses, which are nearly always in sep- 
arate packages and sterilized. The only bad arms I have had were 
those vaccinated by the twelve or fifteen points of glycerinated virus, 
.protected by a paraffin cap. There was no deep seated inflammation, 
•but excessive swelling. The trouble, I think, was due to the fact that 
ithe glycerine points were not thoroughly sterile ; probably the skin 



158 MEDICAL SOCIETY OF NEW JERSEY. 

cocci had gained entrance. Where I have used the glycerinated virus 
in tubes there have been no sore arms, although there has been more 
occasion to revaccinate. 

Dr. CORELius Shepherd, Trenton. — For forty years I have vac- 
cinated, and almost for forty years with human virus. I have pro- 
tected myself from smallpox by human virus. During my experience 
I have attended almost one hundred cases of smallpox, and have had 
no protection except that given by the human virus. During all these 
years, with the use of human virus, it has never been my unfortunate 
lot to witness an arm that was unnecessarily sore, and I have never 
seen gangrene or long-continued suppuration. In the use of bovine 
virus in the last few years my experience has not been so favorable as 
with human virus, prepared by myself, for, as a rule, the arms have 
been sorer than where human virus was employed which had been 
carefully taken from healthy young infants. I believe to-day there 
is no better and no safer virus than that which comes from a pure» 
healthy baby of healthy parentage. It may be true, although I do not 
say that it is so, that unless we are careful in the preparation of the 
bovine virus now being used, there will be greater opposition to vac- 
cination. To-day this opposition is greater than it was forty years 
ago when nothing but human virus was used. How can it be that 
our experiences differ so greatly? Let us be very careful in our 
technique. I am as much in favor of cleanliness as any one else, but 
I have never yet taken the precaution to render the arm aseptic before 
vacinnating. Even during this last epidemic, when vaccinating with 
the glycerine points, there have been no sore arms. I have not used 
the shields nor resorted to antiseptic or aseptic treatment. Such 
treatment must be kept up from the time of inserting the virus until 
the sore has entirely healed, and if this is done the case will require a 
great deal more attention than is usually given to vaccinations. 



The X-Rays as a Cure for Cancer. 

BY DOWLING BENJAMIN, M.D., CAMDEN, N. J. 

When the X-Ray is applied strongly enough to produce a burn, the 
burn does not appear for two or three weeks afterward. This is one 
of the most remarkable phenomena in the domain of medico-physical 
action. A burn from any other cause is instantaneous. 



THE X-RAYS AS A CURE FOR CANCER. 1 59 

What takes place during the two or three weeks when the burn is 
lying dormant, is invisible or incubating, so to speak, we have no 
accurate knowledge ; we only know that some change is taking place 
in the molecular or biologic elements that compose the tissues of 
the human body. A change is going on in the nutrition of the part. 

This is the only example of the kind in medical science a thera- 
peutic agent acting at a distant future time without intervening per- 
ceptible influence. It proves, however, what is vital to our subjtct, 
namely, that the X-Ray has a powerful influence on the inside nutri- 
tion and deep structures of the parts of the liuman body to which it 
may be applied. It is not, therefore, to be wondered at that since 
cancer is a disease of the nutrition and biological or histological tis- 
sues of the body« that the X-Ray should have a marked and peculiar 
effect upon the disease. Experience and practical tests show that the 
X-Ray does modify cancers, and stands to-day as the only thing 
outside of caustic or the knife that will remove the disease. 

The use of the X-Ray as a cure for cancer is of such recent date 
that the question of the permanence of those cures cannot as yet 
be considered as definitely ascertained. 

There have been, as far as I have been able to collect from the 
journals, about twenty cases — actually cured cases — in which there is no 
reason to doubt the diagnosis. Four of the cases are over two years 
standing and have not relapsed. Among the notable cases of cancers 
reported as cured are the four cases of Dr. Wallace Johnson and 
Walter H. Merrill, of Washington. D. C , Sept. 6, 1899. the first case 
of cancer was treated by Drs. Johnson & Merrill. 

These, so far as I know, were the first to be so treated and cured and 
reported. Since the X-Ray goes entirely through the human body, 
can even burn one's flesh through six inches of wood without affect- 
ing the wood, it must necessarily be able to affect internal diseases. 

There are now almost every week cases being reported in the medi- 
cal journals of cancer cured by the X-Ray. 

Recently I have had under my treatment four cases of cancer, all 
epithelioma, and an internal tumor. Having observed some favorable 
reports on the subject by reliable men, I determined to use my 
X-Rays in the treatment of the cases. I have not had the cases under 
the treatment sufficiently long or satisfactorily to report the results 
except in one case. 

A patient fifty years old. The cancer had already eaten away about 



il6o MEDICAL SOCIETY OF NEW JERSEY 

two square inches of the face and nose. The patient improved at 
•once and rapidly, the pain stopped, the sore and raw parts began to 
heal, and in three weeks from the beginning of the treatment the 
patient reported himself well. I hope to be able to keep the run of 
this case in the future. It is now entirely well. 

I would mention the following brief precautions that have been 
found necessary in using this treatment. 

Cover every part of the patient's exposed flesh but the diseased por- 
tion, ulcer or tumor, with tinfoil or thin sheet lead. 

Do not expose the diseased part over ten minutes to a high tension 
•Crook's X-Ray bulb at six inches. 

Protect yourself if you are using the X-Ray much by keeping your 
hands out of the range, as I have noticed slight dermatitis on my 
hands after X-Ray work. It soon disappeared. 

To cure cancer without pain or inconvenience and without the use 
of the knife is one of the greatest discoveries of this progressing 
medical age. It is to be hoped that all cases will be reported until the 
value of the new agent is determined. 

DISCUSSION. 

Dr. Talbot R. Chambers, Jersey City.— I was talking recently 
with Dr. J. E. Stubbert. of the Loomis Sanitarium, who has been using 
the X-Ray for the treatment of tuberculosis. He told me of the case 
of a woman with deformed pelvis and a tumor of the uterus, 
and who was suffering from great pain and metrorhagia. It was 
difficult to make an application of the X-Ray directly, and conse- 
quently the X-Ray was bent at the distal end of a speculum. The 
pain and metrorhagia disappeared and the woman is, temporarily at 
least, well. I wish also to refer to the case of a woman in my own 
practice, who had endothelioma of the epiglottis. She was put upon 
the mixed treatment for a month, and for three months she was given 
increasing doses, but all without appreciable effect. The tubercle 
bacillus was not found in the sputum, and a section of the tumor 
showed it to be an endothelioma. The X-Ray was tried for three 
weeks, the rays being sent through the neck without any appreciable 
effect on the tumor. Dr. Mulvaney applied the X-Ray for me. This 
operator has cured cases of skin cancer by means of the X-Ray, and 
vhe expressed the opinion that heK:ould cure this case. If it is possi- 
ble to send the X-Rays through the tube and then bend them, as Dr. 
Stubbert insists can be done, then it is probable that such a case as 



DISEASE 6f the MIDDLE EAR. l6l 

mine may be successfully treated. I have. here the epiglottis (speci- 
men shown) which was removed recently from this patient. At that 
time the larynx was free, but three weeks later the vocal cords had 
almost disappeared, owing to the exceedingly rapid growth of this 
endothelioma. The microscopist, Dr. G. E. McLaughlin, of Jersey City, 
tells me that this variety of tumor starts from the intima of the lym- 
phatics and of the blood vessels, and that the tumor does not originate 
from the cartilages. The removal of this tumor by the knife has 
started up an active process in the tumor and adjacent structures, 
and now the tissues will be quickly invaded, and the patient's death 
will take place much sooner than would otherwise have been the case. 



Radical Operation for the Relief of Chronic 
Purulent Disease of the Middle Ear. 

BY F. C. ARD, M.D., PLAINFIELD. N. J. 

That chronic purulent otitis may be a source of grave danger to 
the individual is a fact now generally accepted. We have no means 
of knowing the percentage that develop intra-cranial complications, 
but one cannot fail to be impressed with the amazing number of cases 
of sinus thrombosis, lepto-meningitis and brain abscess reported dur- 
ing the past few years. If to these are added the unreported and 
unrecognized cases the total would be appalling. 

That intra-cranial infection should occur so frequently is not sur- 
prising when we consider the conditions existing in a considerable 
proportion of the cases of purulent otitis. As a result of long con- 
tinued inflammation, the bony walls of the middle-ear and antrum are 
deprived wholly or in part of their normal covering of mucous mem- 
brane whose deeper layers perform the function of periosteum. The 
vascular supply of the bone being in some parts directly continuous 
with the lining membrane, the process of disintegration slowly extends 
to the bone and caries is established. The roof of the attic and 
antrum is thin, but when healthy and protected by normal mucous 
membrane it offers an effective barrier against extension of disease to 
the meninges, but when this barrier is weakened by loss of the pro- 
tective covering and caries of the bone exists, extension is likely to 
occur. In many cases the antrum is enlarged and occupied by granu- 
lation tissue and pus, and occasionally cholesteatomatous masses. 
1 1 



l62 MEDICAL SOCIETY OF NEW JERSEY. 

In the mastoid an osteoplastic inflammation has converted the cellvi- 
lar structure to dense bone, at times, of ivory hardness. This condi- 
tion I have found in nearly all cases I have operated upon when 
chronic purulent disease was of long standing. Dench states that it 
is present in all cases to a greater or less degree. 

It is not my purpose to discuss the pathology of the various condi- 
tions found in these cases, but to raise the question, How shall we 
advise our patients who have chronic purulent otitis with caries, par- 
ticularly those cases which are not curable by ordinary methods of 
treatment ? Two cases, whose history I will briefly relate, have 
impressed upon me the necessity of radical operative procedure. 

Case I. J. L.. age, about 45 ; history of chronic purulent otitis for 
twenty years. Occasionally there would be slight discharge from the 
ear. Five weeks before consulting me had caught cold, and since 
that time ear had troubled him. Examination revealed tenderness 
over the antrum on pressure, bulging of post-superior wall of the 
canal, slight facial paralysis on same side. With fine probe dead 
bone could be detected, but view of fundus was unsatisfactory owing 
to bulging of wall. He had severe pain in the ear, particularly at 
night, but no abnormal temperature, no symptoms of paralysis other than 
mentioned, and opthalmoscopic examination negative. Patient was 
advised of the grave conditions and immediate operation urged, which 
he refused. Incision w>^s then made in bulging posterior wall and treat- 
ment directed toward improving drainage. Unfortunately some ameli- 
oration of the symptoms followed, which confirmed the patient in his 
views that he could recover without operation. Some two weeks 
later I was called in consultation by his physician and found patient 
in bed; temperature 102, pulse 80 ; able to reply to a question intelli- 
gently, but cerebration slow ; would lapse into somnolent state; said 
he felt free from pain. Some tenderness over antrum ; no tenderness 
over jugular or over mastoid emissary vein. Temperature had 
remained about the same for two days. A diagnosis of intra-cranial 
infection was made and immediate operation advised, although a grave 
prognosis was given, owing to the probability of lepto-meningitis 
existing. Usual incision made. Opening made directly into antrum, 
removing post wall. Antrum found to be much enlarged and filled 
with foul-smelling pus, remainder of mastoid sclerosed. The antrum, 
aditus and middle-ear cavity were carefully curetted, converting them 
into a single cavity, small bones removed. Membrane canal 



DISEASE OF THE MIDDLE EAR. 163 

incised. External wound closed and drainage secured through canal. 
Condition the following day apparently improved. Death two days 
later. Autopsy revealed serous lepto-meningitis of brain and cord. 

Case 2. C. H., age 9. Admitted to Muhlenberg Hospital with the 
following history : Chronic purulent otitis of several years standing ; 
discharge slight. No treatment had been given. Suffered with pain 
in the ear for several days; condition becoming more serious, the 
family physician was called, who immediately transferred him to the 
hospital. When I saw him temperature was about 103, pulse 80, 
head retracted, complained of severe pains in the head and affected 
ear ; peculiar meningeal cry ; opthalmoscopic examination negative. 
No paralysis. Patient able to reply intelligently to questions. Com- 
plained bitterly of headache. Immediate operation done. The same 
procedure was followed as in case of No. i. In addition the sinus 
was uncovered and found to be normal, the middle fossa was 
opened and dura appeared normal. Death five days later. Autopsy 
revealed extensive purulent lepto-meningitis involving brain and cord. 

In each of these cases the diagnosis of lepto-meningitis was fairly 
well established before operation, and the outlook seemed hopeless, 
yet McEwen advises in these cases the removal of the focus of infec- 
tion, and reports among a number of such cases operated on some 
recoveries. There is no doubt that an earlier operation would have 
saved these patients, yet it would have been a difficult matter to have 
secured their consent to any radical procedure. 

Case 3 had been under my care for persistent oterrhoea for several 
months ; discharge from ear quite free, with small bony particles 
occasionally discharged. An attack of pain in the ear, temperature 
of 102 and tenderness over the antrum decided the question of oper- 
ation. Sclerosed mastoid, enlarged antrum filled with granulation 
tissue and pus, found. Usual operative procedure resulted in rapid 
recovery. Patient entirely well. 

I have no doubt in my mind that intra-cranial infection would have 
occurred in Case No. 3 if operation had not been done. With bone 
of almost ivory hardness toward the mastoid, the path of extension 
would have been in the direction of the cranial cavity as the path of 
least resistance. 

In the three cases mentioned operative interference was imperative. 
There is usually very little difficulty in securing the consent of patients 
or friends where grave complications threaten or exist. 



164 MEDICAL SOCIETY OF NEW JERSEY. 

Case 4 illustrates the more usual symptoms. Miss W., referred to 
me by Dr. Pratt, with history of purulent otitis of many years stand- 
ing, which had resisted every method of treatment. Patient was a 
nurse and frequently called to obstetrical and surgical cases, and con- 
sidered the persistent discharge a menace to her patients. Dead bone 
could be felt with the probe in direction of antrum, and I had no hes- 
itancy in advising operation. Sclerosed mastoid and enlarged antrum 
filled with granulation tissue found. The result illustrates all that we 
can expect from this procedure. In five days stitches were removed 
from the external wound, with primary union established, auricle in 
normal position, no deformity. Three months later complete dermat- 
ization of canal, middle-ear cavity and antrum, with hearing improved. 

It is my custom, when I am consulted by a patient with chronic 
purulent otitis with caries, to put the facts squarely before him and 
advise that, if treatment fails to cure, an operation should be done. I 
tell him that there is a possibility of injury to the facial nerve, and 
that, in a certain proportion of cases, a complete cure is not estab- 
lished. I have had one such case not mentioned among cases reported 
where there is a continuance of a slight discharge. In this case it is 
due to a small carious spot on the promomtory which was not 
observed at the time of operation. 

In an excellent paper on this subject recently read before the Section 
of Otology, N. Y. Academy of Medicine, Dr. Richards took the 
position of advocating radical operative procedure in cases of puru- 
lent otitis when persistent treatment had failed to cure. In the dis- 
cussion which followed such able otologists as Dench, McKernon and 
others endorsed the views of the speaker. It is well known to all of 
you that life insurance companies, will reject an applicant otherwise 
desirable if he has chronic purulent otitis. 

McEwen, who has had an extensive experience with the brain com- 
plications of purulent otitis, says : ** Where the tympanic cavity has 
become the seat of chronic suppuration with ulceration of the mucous 
membrane extending into the antrum and mastoid cells, it becomes a 
standing menace to the safety of the patient. The disease progresses 
insidiously, and one cannot be certain as to where and when it may 
end. A person might as well have a charge of dynamite in the mas- 
toid antrum and cells, as one cannot know the moment when acci- 
dental circumstances may arise which may cause the infected matter 
to become widely disseminated all over the cerebro-spinal system." 



REPORT FROM THE FELLOWS. 1 65 

With practical unanimity of opinion of the best authorities that 
chronic purulent otitis is a menace to life, why should we hesitate to 
advocate a radical operative procedure for its cure ? 

Dr. Holmes advised the treatment of a patient by beginning one 
hundred years before he was born. The same idea might be advanced 
in the treatment of chronic purulent otitis by treating the disease 
when acute. Intelligent management of acute otitis will undoubtedly 
lessen the number of chronic cases. 

It would be well if our patients could be impressed with the fact 
that a chronic discharge from the ear is not a trivial affection, but it 
is worthy of the most painstaking efforts to cure both on the part of 
physician and patient. We must not allow them to believe that 
because a discharge is without odor it is necessarily harmless. It 
may be odorless and yet be highly infectious. 

Unless we are prepared to operate promptly for the relief of intra- 
cranial infection, care must be exercised in removing granulation tissue 
from the middle-ear. It may spring from a dura project through an 
erosion of roof of cavity and serve as a barrier to extension. Its 
removal opens up a channel for infection. 

I fear that many cases of caries are not discovered, because the 
physician does not examine the ear. In some cases the discharge is so 
slight as not to appear at the external orifice of canal. A head mirror, 
speculum and a fine probe will reveal many neglected cases. 

Progress in the management of chronic purulent disease of the 
middle ear has been marked in the past few years, and we may hope 
that with the gradual extension of knowledge of the importance of this 
hitherto neglected disease, a marked diminution in the number of 
intra-cranial infections will occur and a distinct addition made to the 
average length of human life. 



Report from the Fellows. 

« 
BY DAVID C. ENGLISH, M.D., NEW BRUNSWICK, N. J. 

Dr. D. C. English reported on behalf of the Fellows of the Society 
that they had resolved to offer this year, as heretofore, a prize of one 
hundred dollars for the best essay presented and an award of hon- 
orary mention for the second essay in order of merit ; that they had 
chosen as the subject for this year essays : " Vaccination ; " that the 



l66 MEDICAL SOCIETY OF NEW JERSEY. 

conditions would be specified by their Committee on Prize Essay, 
consisting of Drs. J. D. McGill, D. C. English and T. J. Smith, and 
published in the volume of Transactions, and that the prize is open 
for competition to the members of the District Medical Societies. 
He also reported the following resolution which was adopted by the 
Fellows at their meeting held this day : 

" Resolved, That we have heard with profound sorrow of the death 
of our greatly esteemed associate, Henry R. Baldwin, M. D., LL. D., 
and place on record our high appreciation of his worth, and of his 
long, faithful and efficient services in connection with our State 
Society. We recall especially his efficiency as its treasurer, its presi- 
dent and for fourteen years subsequently as the Chairman of its 
Business Committee, and his ever watchful care in guarding its inter- 
ests and honor, and promoting its growth, influence and prosperity." 

•* Resolved, That this action be communicated to the Society and 
a copy thereof be sent to the family with the assurance of our sincere 
sympathy." 

The report was, on motion, accepted by the Society and referred 
to the Committee on Publication. 



The Causes and Treatment of Sterility in 

Women. 

BY EDWARD J. ILL, M.D., NEWARK, N. J. 

Sterility in the woman has caused, since times immemorial, no end 
of mental worry and family discord. With many races the sterile 
woman is treated much like an outcast, and even to this day, and 
among our people, the sterile woman is a most unhappy creature, and 
frequently loses the love of her husband. 

Until within a comparatively short time all of this subject of sterility 
was enveloped in a mist of theory and empirical advice. Since the 
advent-of true biological studies much has been learned, and still 
more since surgeons have opened the abdomen and studied during 
life the faulty conditions of the internal genital organs. Even now, 
however, our knowledge of conception is rather meagre. 

In the management of sterility we must endeavor to produce suqh 
conditions as will facilitate the coming together of the ovum and the 
male sperm and furnish a proper lodging place for the ovum, ._ 



STERILITY IN WOMEN. 167 

We will have nothing to do with such vague phrases as " Deficient 
reproductive energy or want of sexual vigor." The conscientious and 
scientific physician will study the matter as it is presented to him at 
the bedside. 

If you start with the a,xiom that sterility is a symptom of many 
conditions, and not a disease, we will soon learn to look for the latter. 
The frequency of sterility in the writer's own experience is that twelve 
per cent, of his office patients are absolutely so, and longer than two 
years after marriage. Three and one-half per cent, had but one child 
after five years of marriage. One and one-half per cent, had but one 
abortion after two years of marriage. Thus about one-sixth of all 
cases presenting themselves were absolutely or partially sterile. This 
is a condition important enough to ask for our most serious consider- 
ation. 

In the study of this question it will be well to place before ourselves 
facts essential to the production of fecundity. 

I St. The male semen must be normal, /'. ^., it must contain live 
spermatozoa and be deposited near or in the vagina. 

2d. There must be a healthy ovum to come from a female between 
the age of puberty and the climacteric. 

3d. The ovum and spermatozoa must come together, and, 

4th. A proper location for the fecundate ovum must be provided 
in which the new individual can develop to a viable ag-e. 

From what has been said it will be understood that when a sterile 
woman presents herself for treatment we should first assure ourselves 
of the normal condition of the sperm of the husband. The woman 
should not be pronounced sterile until we are satisfied of the husband's 
condition. Unfortunately we have no means to assure ourselves of 
the production of a normal ovum. When the husband's sperm is 
normal, we should then inform ourselves of the normal sexual rela- 
tions of man and wife. The general health and family history of the 
wife may be important. Women of notoriously small families are to 
be considered with suspicion as regards fecundity. 

The male sperm should be deposited in the vagina, though cases 
are known where pregnancy occurred in the presence of a hymen 
through which the little finger would not pass. 

It has been asserted, and one after another repeat the assertion, 
that an acid reaction of the vagina means death to the spermatozoa. 
The writer of this has never been able to verify this, and has seen acid, 



1 68 MEDICAL SOCIETY OF NEW JERSEY. 

alkaline or neutral reaction in both the sterile and the fertile. There 
is a popular belief, much accepted by the profession, that some vaginae 
will expel the semen. The fertile woman will tell us of a certain 
amount of discharge after coition, and close questioning"^ of the sterile 
has revealed to me the fact that the amount of discharge is about alike 
in both. The nervous and hysterical woman will lay great stress .on 
this observation, and is exceedingly unhappy because she cannot 
retain all the semen ejaculated. I would advise to lay no stress on 
this matter. We may say right here that any marked distortion of 
the vagina due to traumatic causes may possibly prevent conception 
for such reasons. 

The uterus is the organ in which, under normal conditions, the fer- 
tilized tgg and the fetus grows to a viable individual. 

That sensitive, hard and large uterus, which makes the woman so mis- 
erable through her whole menstrual life, and which is known as a true 
chronic metritis, offers little hope for a pregnancy. On two occasions 
the writer has succeeded in obtaining a pregnancy after a high ampu- 
tation of the cervix in such cases, but in each case she aborted at the 
third and fourth month. 

In those cases in which we have a badly cicatrized cervix after 
Emmett's operation, with an os possibly at the vaginal junction to the 
right or left, or when a tortuous canal has resulted, thus retaining all 
the mucous discharges, our only hope is in a clean amputation of the 
cervix and smooth scar with an open os, which easily and completely 
drains the cervix. 

Cicatricial stenosis cannot be cured by dilatation. The vagina 
may be dissected away from the remains of the cervix. The cervix 
separated from the bladder in front and the rectum behind and ampu- 
tated. The resulting wound should then be closed by nicely suturing 
thq vagina over it, making a new and efficient os. The same can be 
said of those cases where too small an os has been formed by any 
plastic operation or the result of sloughing in severe instrumental 
delivery. 

It is the last organ that should be thought of as deficient. 

It will hardly be necessary to say that we should not attack the 
uterus for sterility except for sufficient pathological reasons. Much 
disappointment is thus spared to both physician and patient, while 



*" I have had patients catch up the semen in a pomade jar, after intercourse as 
it came from the vagina, and found the quantity in each about the same. 



STERILITY IN WOMEN. 169 

much harm has resulted from indiscriminate surgical measures. 
While our hope lies mainly in the operative features, many cases will 
present themselves in which we can expect little. 

Before we discuss the operative treatment we should study the 
causes, to be the better prepared for the former. While the causes 
enumerated are not constant reasons for sterility, they arc factors to 
be considered. The possible causes of sterility, so far as the uterus 
is concerned, are— 

1st. Mechanical, and, 

2d. Pathological. 

Both may be and often are operative at the same time. The path- 
ological is usually the result of the other, and may need attention 
simultaneously. 

Among the mechanical causes are : 

I St. The various displacements known as versions, flexions and 
prolapse. The displacement known as retro-position of the uterus, 
and due to a shortening of the utero-sacral ligament, is a frequent 
and little known cause. The same can be said of the extreme lateral 
displacements due to congenital shortening of the lateral ligaments, 
or, when acquired, due to cicatricial contractions in the cellular tissue 
at the base of either broad ligament. More will be said of this under 
operative treatment. 

These versions and flexions may be present either with or withotfl 
fixation due to vaginal or peritoneal adhesions ; while displacements 
in themselves are rather infrequent causes of sterility, the accompany- 
ing pathological conditions of the endometrium are improved by their 
correction. In the writers experience, 16.9 per cent., of all sterile 
cases were noted as having one of the various displacements. 

2d. The constriction of the cervix either at (a) the os internum, 
and {b) the os externum are well known and frequent ethiological 
factors, both being represented by about 5.6 per cent. 

Among the pathological causes we have : 

1st. In disease of the cervix uteri : {a) The abnormal shape of the 
cervix, /', e., the long, narrow and conical cervix with contracted os 
externum and dilated canal filled with a thick, glairy mucus, {b) The 
abnormally small cervix, a rare but very fertile source of sterility. (Its 
OS is usually small and the patient in poor health.) {c) Simple hyper- 
trophy of the infra-vaginal and the supra-vaginal portion of the 
■cervix, the former so commonly mistaken for prolapse of the uterus. 



I/O MEDICAL SOCIETY OF NEW JERSEY. 

(</) Ectropium of the cervix is one of the congenital conditions, and 
is a fruitful source of sterility, {e) Among the inflammatory diseases^ 
of the cervix we have those from the simple erosion due to catarrhal 
endocervicitis or endometritis to the severer forms of cystic degenera-^ 
tions due to puerpural injuries or injudicious local medication. 
(/) The injuries due \.o parturition form in themselves a common 
cause of the subject under consideration, {g) The neoplasms in the 
shape of iibromyomata and carcinomata, though the patient rarely 
comes to us to be relieved for sterility when suffering with the latter 
disease. (K) Congenital atresia of the cervix. 

2d. Ki^ox{%\\\^ diseases of the corpus uteri "wt, have: (oC) The 
inflammatory diseases of the uterine tissue itself, exclusive of the 
endometrium. (^) The hyperplastic and inflammatory diseases of 
the endometrium, {c) The local atrophic condition of the uterine 
tissue as caused or produced by flexions, {d) The neoplasms, either 
malignant or non-malignant. 

The writer thinks it will be of interest to study the fibromata as an 
especial cause of sterility. It appears from a very interesting collec- 
tion of cases by Schorler that the interstitial tumors produce sterility 
in 24.7 per cent., and the sub-mucous tumor in 38.8 per cent, while 
the subserous growth is most apt to produce sterility, 47.8 per cent, 
being sterile. It would appear, then, that the subserous tumor pro- 
duces the largest number of sterile women, likely due to the displace- 
ment of the uterus and tubes, the tortuosity of the canal, and the 
inflammatory condition of the peritoneum. 

Winkel tells us that 24.3 per cent, of all women with mybmata are 
sterile, while Gusserow makes it 27 per cent., Rohrig, 25 per cent.» 
and E. von Flammer Dinghe (reporting 1.385 myomatous uteri) 32: 
per cent. Susserott has observed that myomatous women give birth 
to 2.7 children as an average, while the average for other women, in 
the location where he compiled his statistics, was 4.5 children. In the 
writer's own^experience 18.3 per cent, of all sterile women were affected 
with myomata. 

It is a well-known fact that the percentage of sterile marriages is 
about 10 per cent. We have thus as a result of myomatous uteri an 
increased sterility over the normal of from 14 to 22 per cent. It is ta 
be considered, however, that a certain percentage of fruitful women 
with myomata, presenting no symptoms, have no reason to apply to 
the physician for advice, and, furthermore, that a certain percentage 



STERILITY IN WOMEN. 171 

of myomatous women will present themselves for treatment because 
of their sterility. Both are thus actually raising the percentage of 
sterile women with myomatous uteri. 

Winkle has furthermore shown that the plurality of children is much 
reduced in the myomatous woman, hardly 1.2 per cent, are multipara, 
/. e,, such as have six or seven children, while for Saxony the normal 
percentage of multipara is 22.1 per cent. 

The causes of sterility due to myomata must be carefully studied if 
we wish to form a conclusion in regard to operative measures. 

Besides changes of the endometrium and adnexa we have the 
irregularities of the cavity of the uterus, its elongations, the pressure 
of the tumor so as to occlude the tubes or cavity, and the displace- 
ments of the uterus itself. Hofmeier has lately denied that these 
growths produce sterility at all, because most women do not develop 
myomata until after their thirty-fifth year. He fails to speak, 
however, of those true metoritic changes, which we find so common 
in young women and which the writer thinks are the forerunner of 
the small myomota. The writer's own experience, which tells us that 
nearly one-fifth of all sterile women have myomata, presents an im- 
portant consideration in this regard. 

Lastly we have those conditions which are due to imperfect devel- 
opment, /. /., the infantile and rudimentary uterus and the normal 
atrophy due to the menopaus. 

3d. operative Sterility. Under this heading we are reminded of : 
{a) Those septic conditions of the uterus following operative in- 
terference, {b) Laceration of the cervix of greater or lesser extent 
following forcible dilation of that organ, {c) Emmet's operation 
for repair of the cervix improperly done, {d) Caustic applications 
producing cicatricial stenosis and retention of uterine mucus, or 
even partial or complete obliteration of the cavity, {e) Awptita- 
Hon of the cervix producing an unduly small os and retention of 
uterine mucus. (/) The Porro and other operations which demand 
removal of the whole uterus. 

We have thus, in as few words as possible, spoken of the causes of 
the subject under consideration. 

The operations for these causes must often be combined with 
curettage and drainage of the uterus. 

All displacements should be remedied by proper operations, other 
means having failed. For mobile retroflexions and versions the 



lyz MEDICAL SOCIETY OF NEW JERSEY. 

Adams-Alexander, Gilliam and Mathew D. Mann operation have 
given the writer the best results. When these displacements are 
complicated by disease of the cervix, either simple hypertrophy or 
laceration with hypertrophy and erosion, amputation of that part of 
the organ at the vaginal junction should precede the operation on the 
round ligaments, and the hyperplastic endometrium should be 
removed by curettage. In such an amputation the wound should be 
as smooth as possible. The new os should be made so that there 
will be no exposure of the cervical mucous membrane and the re- 
sulting scar smooth and pliable. The os should be open for com- 
plete and easy drainage of the cavity of the uterus. 

For the 6xed flexions or versions the Gilliam operation is the one 
most to be preferred after adhesions have been separated by the 
finger or cautery. 

Prolapse presents such a combination of diseases that the writer 
can only say that here also a Gilliam operation will be one of the 
many very desirable and valuable means to secure the desired end 
accompanied by such other plastic work as may be called for. 

Vaginal and abdominal fixation should never be practiced while a 
woman is in the active period of sexual life. The last ventral fixation 
done by the writer for prolapse was for a woman in the forties, who 
had been sterile for ten years. She promptly became pregnant and 
had to be delivered by Caesarean section. 

There are two classes of cases of retroposition of the uterus due to 
short and sensitive utero-sacral ligaments that come to us for treat- 
ment. The milder forms will do well by very thorough and complete 
stretching of the ligaments under an anaesthetic. As the condition is 
commonly combined with an acute flexion of the body ; a dilatation, 
curettage and the insertion of a large glass plug for a week should 
follow the stretching of the ligaments and at the same sitting. This 
will cure most cases. There is a form which is apt to relapse. 
When, after repeated stretchings, such is found to be the case, the 
abdomen should be opened, the utero-sacral ligaments cut crosswise, 
as recommended by Dr. Burrage, of Boston, and the wound sewed 
up in the reverse. The uterus is then drawn forward and a Gilliam 
operation performed. 

The treatment of each of this class of cases has given the writer 
the greatest amount of satisfaction. 

Retroposition is now and then combined with an extreme lateral 



STERILITY IN WOMEN. 1 73 

displacement. Here again we must stretch the short ligament by 
massage, under an anaesthetic and keep the uterus in position by 
gauze, packed to the shorter side, after we have introduced a glass 
plug into the uterus to act as a lever. 

It is often denied that constriction of the os externum or os 
internum are mechanical causes of sterility. The proof is, that their 
complete and thorough dilation is commonly followed by a pregnancy. 

For the constrictions at the os internum, whether connected with 
or without flexion, dilation with steel sounds to a number thirty-six 
(French), followed by the wearing of a glass plug of a number thirty- 
two for six days has given the most desirable results. For the con- 
striction of the OS externum the crucial incision and excision of Dr. 
Mund6 has been curative in most cases seen by the writer. 

The conical shaped cervix of milder type will be relieved by dilation 
with steel sounds as spoken of above. In the extreme form it will 
be wise to amputate the cervix at the vaginal junction. That great 
care should be exercised to adapt the wound nicely has already been 
touched upon. 

For the infra-vaginal elongation of the cervix, amputation at the 
vaginal junction will promise good results. 

The same can be said of what the writer consideis to be congenital 
ectropium of the cervix. These women are almost invariably sterile 
and an amputation offers them a very good chance for pregnancy. 

For the severer type of cystic degeneration and thc»severer form of 
injury, due to parturition, amputation again is the simplest and most 
desirable operation. In the simpler forms of laceration Emmelt's 
operation still has a place in surgery and has given the writer many a 
nice result. 

While fibromata of the cervix should be promptly dealt with by 
enucleation the writer dare say that few of us would attempt to save 
the uterine body when the cervix is the subject of malignant disease, 
simply to hope for a future pregnancy. Here, surely, a deplorable 
result must be anticipated. 

Among the operations for sterility due to disease of the uterus the 
removal of fibromata will interest us most. The writer is not partial 
to conservative myomectomies as done through the vagina except 
those in the cervix and those in the cavity of the uterus. The scar 
resulting in the cellular tissue under the vagina and in the vagina 
itself forms an objectionable after-result. The uterus is frequently 



174 MEDICAL SOCIETY OF NEW JERSEY. 

dragged from its normal position and its mobility impaired. Our 
efforts are thus fustrated while frequently painful scars will result. 

Wounding the normal tissue of the uterus with vulsella and 
traction hooks is also greatly to be feared in this method of operation. 

There will be less wounding of pelvic cellular tissue when oper- 
ating through the abdomen, a matter greatly to be desired. The 
wound will be clean cut and its closure can be accomplished with 
the greatest nicety. The fewer the nodules the more can be prom- 
ised in the way of a pregnancy after their removal. A large size 
within a certain limit, will be of little moment. Tumors near the 
horns of the uterus and such as produce extreme displacements 
promise well for a cure pf sterility. Of late years much has been 
attempted in the removal of a large number of nodules. The writer 
believes that surgeons will soon recognize this as a mistake. He 
would suggest that the removal of myomata should be practiced 
only when a few nodules are present if we hope for future preg- 
nancies. While many of us have seen pregnancy follow myomec- 
tomies, but two, so far as the writer knows, have practiced the oper- 
ation for the sole purpose of the cure of sterility. They were Dr. 
Edmund Reynolds, who operated once without success, while Dr. J. M. 
Duff recommended and operated twice, both cases proving successful. 

There is thus a new indication given for the removal of my- 
omata. tumors that have been devoid of all subjective symptom, but 
are the possible cause of sterility. 

Because of the frequency of pathological conditions of the adnexa 
in myomatous uteri the indication would be only another step for a 
combination of operations. 

The diseases of the tubes and ovaries should next attract our at- 
tention. Seventeen per cent, of the writer's sterile cases (see table) 
were due to inflammatory disease of tubes and uterus, most frequently 
gonorrhoeal. 

Simple catarrhal and purulent inflammatory diseases of the tube, 
either in their primary stage or the secondary results therefrom, are 
the conditions Which are presented to us most commonly as the cause 
of sterility due to this organ. Tortuosities, closure of the fimbriated 
ends, pyo, hydro, and hemato-salpinx, displaced and adherent tubes 
and destructive changes of the mucosa present themselves for our 
consideration. Gonorrhoea and more rarely septic infection are the 
causes. Periovarian and uterine adhesions commonly result and form 
factors in the disease. 



STERILITY IN WOMEN. 1 75 

Little can be said at the present time in regard to what diseases of 
the ovary produce sterility. We shall not go far amiss, however, by 
attributing a great thickening of that epithelial layer called the 
tunica albuginea and a hypertrophy of the cellular tissue of the ovary 
as a cause of sterility. 

The writer has seen thickening which prevented the bursting of 
the graafian follicle, while great increase in the cellular tissue would 
prevent the growth of the germinal cell. 

Since the noteworthy publication of Dr. Polk on the subject of con- 
servation of the ovaries in 1^87, our attention has been directed to 
this subject for the' purpose of keeping up the normal menstrual 
function so desirable in thie normal woman during her active sexual 
life. With this there was a faint hope of securing a condition per- 
mitting a pregnancy in the future. This hope was realized when he 
published, in 1891, the occurence of pregnancies following such oper- 
ations. When, however, we are told to do intra-abdominal operations 
for the sole purpose of the cure of sterility we are arriving at the 
climax of the art of abdominal surgery. This not only merits our 
highest approbation but also our most serious consideration. The 
first intimation we have had of operating for such an indication solely 
came to us from the same author in a paper read before the American 
^gynaecological Society in 1893, when he distinctly formulated as 
proposition 3 : " That the appendages may be operated upon to the 
promotion of child-bearing." 

In a most excellent paper read before the New York County Society 
on January 27lh of this year, Dr. Polk presents to us the lofty and 
ideal proposition that we should operate on the ovaries and tubes when 
they are found diseased for the sole reason and cure of sterility. 

Whether we look at this matter from the lofty view of a sentiment 
and duty or whether we look at it from the view of the naturalist we 
must say to ourselves that in the vast majority of cases the ideal cure 
of the patient is obtained only when pregnancy is possible. Hitherto 
this has been a secondary consideration. 

Surgeons are apt to go off on a tangent and we must beware of 
encouraging a condition of things which may do an enormous amount 
of mischief. In such able hands as those of this gentleman we may 
trust such high-class work with the greatest confidence. Besides, he 
has evidently allowed his experience only to dictate this suggestion, 
ior nine years have elapsed from the time when he said, "The ap- 



176 MEDICAL SOCIETY OF NEW JERSEY. 

pendages may be operated upon to the promotion of child-bearing ** 
until he says that " The diseased tubes and ovaries should be oper- 
ated upon for the sole reason and cure of sterility." 

The writer of this has done abdominal sections for twenty-four 
years, but he has never operated for the removal of the uterine ap- 
pendages except for palpable diseases. We are now asked to oper- 
ate, though not for the removal of these organs, for diseased con- 
ditions of the tubes and ovaries, which can be felt by the finger in a 
certain proportion of cases only. Oftentimes these are conditions 
which are surmised and suspected symptomatically and theoretically, 
rather than otherwise. Some may say that we leave the safe and 
sure method of palpation, and return to exploration and speculation. 
This, I am sure, is neither a dangerous nor a backward step when we 
do it not to remove the adnexa, but to cure them. There is a great 
difference between doing an operation for sterility, incidentally, and 
doing it for that specific purpose only. 

Heretofore the writer has been very conservative in the advisability 
of any surgery on the tubes and ovaries. He has only operated on 
the very bad and commonly suppurative cases. From what he can 
learn from the work of other surgeons, the conservative operative 
work on the tubes, ovaries and uterus is most commonly done in such 
cases for which he has been accustomed but exceptionally to advise 
any surgery at all. There are other lines of treatment, though slow 
and tedious, which will succeed equally well, in a majority of cases to 
cure symptomatically. In the cases where he was obliged to operate 
the conservation must remain the exception. Even in these excep- 
tions he has had the pleasure of seeing symptomatic cures and preg- 
nancies follow ; but the frequency of secondary operations necessary 
to cure some patients has marred the pleasure. For that reason he 
has done more conservative work for from five to eight years ago 
than he had done from that time up to November, 1901, when Dr. 
Polk's proposition was brought to his attention. 

About one case out of five are reported as becoming pregnant fol- 
lowing operation, considering the figures of Drs. Polk and Dudley, of 
New York, and Dr. Burrage, of Boston, the three gentlemen whose 
high class work in this direction deserves special commendation. 

How much of these results are due to the correction of displace- 
ments, the cure of inflammatory disease by rest in bed and temporary 
freedom from sexual intercourse can only be guessed at. 



STERILITY IN WOMEN. \^^ 

The writer has in vain looked up a record, published somewhere by 
a German gynaecologist, in which it is asserted that 60 per cent, of 
women only remain sterile after gonorrhoeal infection of the uterus and 
tubes, a result better tljan which surgery has not yet succeeded. But 
again, it is just in some of these 40 per cent, of sterile women that 
•come to us for the relief of sterility that we are to deal with. They 
are often such cases that cannot afford a long and tedious treatment 
and who beg for operative and quick measures for relief. It is these 
poor women that Dr. Polk's suggestion, *' to operate for the sole pur- 
pose of the cure of sterility," comes like a light from heaven. The 
suggestion so completely dazzled the writer that he wondered how 
many prominent gynaecologists in this great country of ours thought 
of such an indication for an abdominal section. He promptly wrote 
to over one hundred, and received positive answers of only three. 

The poor sterile woman who haunts our consultation room to find 
relief demands our deepest sympathies, and with the experience of 
accidental pregnancies following conservation of the adnexa for other 
purposes, the suggestion will give new hope and life. Dr. Dudley, in 
the Journal of the American Medical Association of August 10, 
1 901, truly says : *' It must be borne in mind that only a very small 
•number of cases for which one man is called on to make an abdominal 
section will be a suitable one on which to do conservative ovarian sur- 
gery." The writer would add that the number presenting themselves 
for the cure of sterility, due to ovarian and tubal diseases must be 
indeed very small, and that it will take many years to gather much 
experience. This will be the more so when we consider the very 
interesting and profitable paper written by Dr. Burrage, who finds in 
his experience that while 34.5 per cent, of the cases become pregnant 
who- have had children before, "only 6J per. cent of those previously 
sterile subsequently become pregnant " ; and, furthermore, that " in 
no instance did pregnancy result after the resection of the closed tube, 
both tubes being closed at the time of the operation." 

The suggestion of Dr. Polk furthermore offers a point in favor of 
preventive medicine. Our ectopic cases, in the vast majority of 
instances, result from diseased and fixed tubes. In the separation of 
the adherent condition of the tubes, we offer our patients a chance of 
escaping this dreaded accident. Furthermore, it will be our duty 
hereafter to operate in a conservative fashion in ectopic pregnancies 
with a view to future normal gestation. The writer has removed the 

12 



178 MEDICAL SOCIETY OF NEW JERSEY. 

product of ectopic gestation four times without sacrificing tube or 
ovary when there was an attempt at tubal abortion. One again 
became pregnant and was delivered at term. In another case he 
curetted the product of conception from a rent in the tube near the 
uterus and closed the rent with fine suture. In a sixth and last case 
he removed the tube containing the fetus because of its great destruc- 
tion and opened a closed tube on the other side with a cautery. The 
last case resulted in a pregnancy and delivery at term within sixteen 
months after the operation. 

These small number of cases are but a hint of what could be done 
under similar circumstances. 

The time allotted to the reading of this paper is too short to talk at 
length of the selection of cases of tubo-ovarian diseases that offer a 
reasonable chance for such cure or of the operation advised. For 
the tubal disease it is only necessary to say that it should be resected 
where it appears healthy and where there is a reasonable hope to find 
it pervious. The mucous membrane is stitched by fine suture to the 
peritoneum after the tube has been slit open. All adhesions about 
the uterus, tubes and ovaries should be carefully broken up, and any 
long strands be removed with the scissors. Bleeding points should 
be carefully secured by fine catgut suture, and there should also be a 
most careful toilet of the peritoneum. If there is the slightest tend- 
ency of the ovary or uterus to a retroposition or prolapse, the round 
ligaments should be fastened forward after the suggestion of Dr. 
Gilliam or Dr. Mann. The writer is sorry that he is obliged to pre- 
sent to you this important subject to you in so fragmentary a manner. 
The subject is large enough to fill a book. This paper will have fulfilled 
its mission if it draws your attention to this most important and fre- 
quent condition. 



Out of the seventy-one* successive and absolutely sterile cases, the 
cause of sterility was attributed to — 

Chronic vaginitis, gonorrhoeal, - - - 2 

Purulent vaginitis and endometritis, dysparennia, - i 

Chronic gonorrhoeal endometritis, - - - - 4 

Catarrhal endometritis, - - _ - i 

Hyperplastic endometritis, - - - - 2 



STERILITY IN WOMEN. I79 

True chronic metritis, _ _ . - i 

Endocervicitis catarrhal, left lateral displacement, - i 

Chronic gonorrhoeal salpingitis and ovaritis, - 10 
Tubes and ovaries removed for gonorrhoeal salpingitis and 

ovaritis, - ... - . - i 

Stricture of os internum, - - - - 4 

Retro-lateral position, stricture of os internum, - 2 

Retrofiexed uterus, _ - - - 3 

Retroverted uterus, ----- 2 

Retroflexed adherent uterus, - - - 3 

Anteflexion of cervix and corpus uteri, - - 2 

Extreme right flexion of corpus uteri, - - i 

Para-metritis posterior, - . - - 4 

Prolapsed ovaries, _ _ - - i 

Chronic salpingitis and myoma uteri. - - - i 

fFibro-myoma uteri, - - - - 15 
Cancer of the cervix ; history of chronic cervical disease, 2 

Intra-ligamentous ovarian cysts, - - - i 

Infantile uterus,- . _ . . - 2 

Sterile husband, ----- 2 

Prevents conception, - ,- - - - 3 

♦Represents 12 per cent of all the cases of my case-book taken for 
the purpose of those figures. 

fOne myoma found pregnant at six months after fourteen years of 
sterility. 

One myoma found preghant at three months after six years of ster- 
ility. 

DISCUSSION. 

Afr. President and Members 0/ the Ntw Jersey State Medical Society : 
We are indebted to Dr. Ill for an excellent paper upon a very im- 
portant subject. Sterility is responsible for a great deal of mental 
suffering on the part of the barren women as well as much domestic 
unhappiness. Unlike the Pharisee who said, " Lord, I thank Thee 
that I am not as other men are," the barren woman bemoans her fate 
because she is not as other women are. Since the earliest times ster- 
ility has been considered a reproach, and the life of many a woman 
has been sad because she was childless. When Rachel said unto 
Jacob, '• Give me children or else I die," she voiced the sentiment of 
many a childless wife since her time. Some sterile women desire to 
become pregnant merely from amour-propre. They only want to 



l80 MEDICAL SOCIETY OF NEW JERSEY. 

demonstrate the fact that they have the capacity for child-bearing ; 
for after they have been cured of their sterility and have borne one 
child they will go to any length to get rid of the products of a subse- 
quent conception. I have seen several such The subject of sterility 
is too vast to be properly discussed in a few minutes, but I shall 
endeavor in the short time at my disposal to pass in review some of 
the important points in connection with this interesting condition. 
Sterility may be absolute or relative, congenital or acquired. Relative 
sterility is that condition in which a woman is sterile in relation to one 
man, even though he be healthy, while she is fruitful in relation to 
another. Such cases are far from uncommon. In many cases hus- 
band and wife have cohabited for years without issue. They have 
then become divorced and both have married a second time, and their 
marriages have been fruitful. While the possibility of the interven- 
tion of a third party is not to be denied, this would not affect the 
point under consideration. This relative sterility is also observed in 
the lower animals. A mare may be bred to a healthy, vigorous 
stallion several times without conceiving, but as soon as she is mated 
with a different horse she becomes with foal. Absolute sterility is 
due to causes which preclude the possibility of conception as long as 
they continue to operate. Congenital sterility, as its name implies, is 
due to abnormalities of the genital tract existing at birth, while 
acquired sterility is due to traumatisms or inflammatory affections of 
the generative organs acquired later in life. Sterility may be due to a 
great variety of causes, and in every oase it is desirable to determine 
positively at the outset what the conditions are which prevent concep- 
tion. In many cases the cause is easily detected, while in others the 
most painstaking examination fails to reveal any reason why the 
woman does not become pregnant. In such cases the Friench proverb 
applied to mysterious criminal cases, " Cherchez la femme," should 
,be reversed, and we should say, *' Cherchez l' homrae," for the cause 
of the sterility in such cases often resides in the generative apparatus 
of the husband. 

Causes. — Taking the generative tract from below upwards the fol- 
lowing conditions may be found to exist, either of which may act as a 
bar to conception : Tough, thick or imperforate hymen ; hypertrophy 
of clitoris; tumors of labia majora or minora; atresia of vagina or 
cervix uteri ; neoplasms of vagina or cervix ; stenosis of cervical canal ; 
.cervical and corporeal endometritis ; neoplasms of uterine body ; ver- 



STERILITY IN WOMEN. l8l 

sions and flexions of the uterus ; congenital absence or imperfect 
development of uterus and ovaries and atrophy, the result of super- 
involution. Inflammatory adhesions of tubes and ovaries resulting 
from gonorrhoeal infection is a frequent cause of sterility. Certain 
lesions of the vaginal canal, such as vesico and recto-vaginal fistula 
may act as causes of sterility, while irritable carunculse-myrtiformes, 
urethral caruncle, fissure of the vagina or anus and haemorrhoids may, 
by inducing violent attacks of vaginismus, cause a suspension of all 
attempts at coitus. 

Treatment. — The treatment of sterility consists in removing its 
cause. The importance of a correct diagnosis cannot be overesti- 
mated, for by knowing early the real state of the case the practitioner 
may enhance his reputation for integrity, and save the patient's time 
and money, in an incurable case, by stating plainly that there is no 
hope of cure. If the cause can be removed a cure may follow, if the 
cause is irremovable the case is hopeless. The cases of sterility 
which have interested me most have been those which were depend- 
ent upon stenosis of the cervix, versions, flexions, endometritis, neo- 
plasms and adhesions of the adnexae. In uncomplicated stenosis of 
the cervical canal, simple dilatation with Peaslee's Dilators has given 
me successful results in a large number of cases. Of all the varieties 
of displacement, congenital* anteflexion has proved the most rebellious 
in my hands. Retroflexion and retroversion, whether congenital or 
acquired, if uncomplicated by endometritis or diseased adnexae may 
be successfuly treated by the use of a properly applied pessary. 
It should be noted that I say a '* properly applied " pessary. Un- 
fortunately, the average practitioner knows less about the indica- 
tions for the use of pessaries and the proper method of using them 
than he does about the course of the vidian nerve or the branches of 
the ophthalmic artery. It should be borne in mind that a pessary is a 
splint, and that in every case the first thing to do is to reduce the dis- 
location of the uterus and then apply a pessary which will maintain 
the organ in a normal position. What would be thought of a surgeon 
who would apply a splint to a dislocated elbow-joint without first 
reducing the dislocation. To this it might be replied that the surgeon 
is supposed to possess some brains and a little common sense, 
while these commodities may be dispensed with by those \vho confine 
their practice to the obscure domain bounded by the walls of a 
woman's pelvis. Be this as it may the fact remains that the soi-disant 



1 82 MEDICAL SOCIETY OF NEW JERSEY. 

gynaecologist often introduces a pessary apparently with no other 
motive than to hold the uterus in its abnormal position; unfortu- 
nately for the patient he generally succeeds. The proper method of 
applying a pessary in cases of posterior displacement is as follows : 
The rectum and bladder having been emptied and the clothing 
loosened about the waist the patient should be placed in the knee- 
chest position and the posterior vaginal wall retracted. This, of 
itself, is often sufficient to reduce the dislocation by pneumatic 
pressure, but when the uterus is large and incarcerated in the con- 
cavity of the sacrum it is necessary to introduce two fingers and raise 
the fundus above the sacral promontory. The posterior vaginal 
wall should be retracted by a Sims speculum and the pessary intro- 
duced. The woman should then be turned on her left side and the 
pessary properly adjusted. The patient should then walk about the 
room, and sit down and get up from the chair several times to ascer- 
tain if the presence of the pessary causes any discomfort. When a 
pessary is properly applied the woman is unconscious of its presence 
in the vagina. Only an imbecile would send a patient away wearing 
a pessary which caused discomfort, not to say pain. 

When reduction by the fingers is impossible (and these cases are 
rare), the patient. should be placed in Sims position. Sims speculum 
should be introduced and the cervix exposed, then by means of a 
uterine sound the fundus may be restored to its normal position. I 
have successfully practiced this manoeuvre on many occasions and 
have never had any bad results, but I realize that when used for this 
purpose the uterine sound in the hands of a careless or inexperienced 
man is a dangerous instrument. 

When sterility is due to adhesions of the adnexas to contiguous 
structures, as the result of gonorrhoeal or puerperal infection, the 
abdomen should be opened, the adhesions separated and conservative 
operations performed upon the tubes and ovaries. But in this class 
of cases sterility /^'r j(? is not the indication^ for operation, but the 
pathological condition upon which the sterility depends ; and accord- 
ing to my experience the appendages in these cases are, as a rule, so 
hopelessly damaged that their complete removal is imperative. So- 
called conservative operations under these conditions are likely to fail 
in giving relief to the symptoms, and the operator fails to cover 
himself with glory, as he hoped to do, by curing the patient of her 
sterility. 



STERILITY IN WOMEN. 1 83 

Endometritis, accompanied by menorrhagia or metrorrhagia and 
profuse leucorrhoea, is sometimes a cause of sterility. It is generally 
amenable to thorough sharp curettage followed by antiseptic irriga- 
tion and packing of the uterus with iodoform gauze. 

Within eighteen months I operated on a rather complicated case of 
this nature. The patient was forty, had been married nineteen years, 
and had never been pregnant. She had profuse menorrhagia and 
leucorrhoea, and suffered greatly at her menstrual periods. She was 
a very nervous and timid woman. Before coming to me she con- 
sulted a gynaecologist in New York, who found a tumor of the cervix 
and proposed an operation for its removal. This she declined. She 
was brought to me by a trained nurse, who was a personal friend of 
hers. When I proposed an operation, she astonished me by promptly 
consenting. A few days later I removed the tumor, which was a 
myoma of the cervix as large as an orange, and removed from the 
uterine cavity, with the sharp curette, the largest amount of fungoid 
tissue that I have ever seen removed from any case of endometritis. 
The uterus was irrigated and the uterine cavity packed. The patient 
made an excellent revovery. and three months later became pregnant 
and in due time was delivered of a healthy boy, who is the pride and 
joy of her heart. 

When uterine myomata act as a bar to conception, they may be 
removed by myomectomy if that operation is feasible. But, as in the 
case of large myomata the appendages are often diseased, myomec- 
tomy as a cure for sterility may be rather disappointing. Infantile 
uterus as a cause of sterility is far from uncommon. During the past 
two years I have seen eleven cases. All the women were healthy 
looking, the vaginae and vulvae were normal, and, in a majority, the 
breasts were fairly developed. The menses were scanty, but, in most 
of the cases, regular. The patients consulted me merely on account 
of their sterility, for which, of course, I could give no relief. 

Dr. W. E. Carroll, Newark. — It would indeed be a difficult 
matter for me with the limited time at my disposal to convey to you 
the very deep interest I feel in the subject of Dr. Ill's paper, an inter- 
est, I believe, all physicians feel to a certain extent. We should feel 
thankful for having the matter put before us in so clear and forcible a 
manner as has been done by Dr. Ill's paper. I had the pleasure of 
hearing Dr. Polk's paper, to which allusion has been made to-day, 
and I could well wish that copies of both of these papers could be 



1 84 MEDICAL SOCIETY OF NEW JERSEY. 

placed in the hands of every physician and surgeon in the land, with 
the hope that some of the enthusiasm of the writers might enter as a 
leaven, so to speak, into the mass of the medical profession in order to 
produce an awakening to the glorious possibilities opened up to us, 
by following the lines indicated in those papers, enabling us to fulfil 
our duties to the human race in so much more complete a manner 
than we have hitherto been enabled to do. 

Whether we look at this subject from a sentimental point of view 
or from the naturalist point of view we must feel that hereafter it can 
not take a secondary position. I would beg leave to suggest that 
there is still another point of view : — /. ^., that of every lover of his 
country— the patriot's point of view. Granting this it becomes still 
more a duty, doubly so, and where is the physician, the good physic- 
ian, the true physician, who was ever known to shirk his duty once 
he became convinced of the lines wherein that duty lay ? 

We should then do everything in our power to assist our beautiful 
and beloved country in advancing to the front in the race of the 
the nations, and to prevent as far as we can, so direful a calamity 
befalling us, as has befallen another beautiful but unfortunate country 
whose government has been compelled to offer a prize or premium, 
or bribe, call it what you will, to bring the birth rate up to a point 
beyond the death rate. I need scarcely say that I refer to France. 

With regard to Dr. Ill's paper, the statistics given are doubtless 
correct, but they are dangerous things to meddle with. If there is 
anything in statistics, that makes more trouble than the figures it is, 
perhaps the facts. 

One cause of sterility, or what I might designate as secondary ster- 
ility, if I may be allowed the expression, is the too early application 
of the forceps during labor (even by able men), before the cervix is 
out of the way, /. e., before it is fully dilated. The results are always 
bad, sometimes appalling. The cervix is lacerated through the vagina, 
also through the fornix into the base of the broad ligament, the head 
of the child comes down, or \s pulled down, upon an unprepared peri- 
neum, lacerating it badly, and sometimes completely through the 
sphincter. 

These patients then are in a dangerous condition, and arise fro.m 
their beds, if they arise at all, ailing women, and they remain so, a 
reproach to the author of their condition, sometimes conceiving but 
always aborting. 



TETANUS COMPLICATING VACCINATION. 1 8$ 

The only hope for these poor sufferers lies in an operation, or a 
series of them — an amputation of the cervix, a removal of all cicatri- 
cial tissue, as far as possible, and repair of the perineum. Many then 
conceive and are delivered at term. I refer to this because it had 
unfortunately to be omitted in Dr. Ill's paper, owing to lack of time, 
and because of its great importance. 

I thank you for your attention and regret I have not more time 
allotted to me. 



Tetanus Complicating Vaccination. 

BY ALEXANDER MCALISTER, M. D., CAMDEN, N. J. 

In the Autumn of 190T, when smallpox was quite prevalent 
throughout many cities of the Union, and the need of vaccination 
and revaccination was strongly emphasized, the country was startled 
by the development, in rapid succession, in Camden, New Jersey^ of 
ten cases of tetanus in persons recently vaccinated. Eight of these 
ran short courses, ranging from one day to a week, and ended 
fatally. Two cases were rather protracted and ended in complete 
recovery. The occurence of this outbreak has proven of intense 
medical interest in all civilized countries, and has raised many vital 
questions, some of supreme importance. 

The writer does not wish to engage in either pros or cons. He 
has no theory to advance nor conclusion to supporL The outbreak 
has been thoroughly investigated in all its intricate questions of cause 
and effect, present and remote. Much has already been written upon 
the subject, some wise and some otherwise. 

The object of this paper is to present for record in the medical 
archives of the New Jersey State Medical Society, a concise history of 
this outbreak of tetanus and the result of the investigation which 
followed. 

The cases all appeared within the limits of Camden during the 
month of November, 1901. The following is a brief history of each 
case : 

^ No. I. — W. J. B., age 7 years; white; vaccinated October 12th, 
with glycerinated virus from a capillary tube, marked *' Good until 
12-26, *oi." Aseptic precautions used before vaccination. Symp- 
toms of tetanus appeared November 1st. At this time, the primary 



1 86 MEDICAL SOCIETY OF NEW JERSEY. 

vaccination scab had been lost and the wound presented a healthy 
condition. The case rapidly grew worse, developed typical tetanus, 
and died November 3d ; period of illness three days. 

No. 2. — \V. B.,age 8 years; white; vaccinated October 14th, with 
glycerinated virus from a capillary tube, marked "Good until 12-26, 
'01." Aseptic precautions used before vaccination. Symptoms of 
tetanus presented themselves November 4th, at that time the arm 
was swollen, the wound presenting a dry and black appearance and 
emitting a bad odor; the wound was curretted and treated. Tetanus 
antitoxin was administered with other proper remedies. Result, 
complete recovery. 

No. 3, — A. M. W., age 11 years; white; vaccinated October 19th 
with glycerinated virus from a tube marked ** Good until 12-10, '01.*' 
Aseptic precautions used before vaccination. Symptoms of tetanus 
appeared November 6th, rapidly increased in violence. Death occurred 
November 8th ; duration of illness, two days. 

No. 4. — F. ^C., age 5 years ; white ; vaccinated October 25th, with 
glycerinated virus from a capillary tube. Aseptic precautions used 
before vaccination. On the evening of November 8th he com- 
plained of stiffness of the cheek muscles. Twelve hours later a typ- 
ical case of tetanus had developed and the patient died at 3 P. M. of 
the same day ;* duration of illness one day. This boy's home was 
within fifteen feet of a stable, not very cleanly kept, where he played 
much of his time. 

No. 5. — L. E. C, age 16 years; white; vaccinated October 14th, 
with dry virus from an ivory point marked " Good until 12-10, '01." 
Aseptic precautions'used before vaccination. Symptoms of tetanus 
appeared November 5th, 1901. The arm was then inflamed and 
presented an open irregular sore. The shield had adhered to the 
wound from the excessive discharges. The patient seemed to 
improve somewhat for a time, but later convulsions ensued and she 
died November 15th; duration of illness, seven days. 

No. 6. — T. B. H., age 11; white; vaccinated October 23d, 1901, 
with glycerinated virus from an ivory point, marked " Good until 12-10, 
01." Aseptic precautions used before vaccination. Symptoms of 
tetanus appeared in mild form November nth, 1901. On the follow- 
ing day convulsions set in. Patient died 4.15 A. M., November 13th ; 
duration of illness, two days. 

No. 7 — A. B. C, age 9 years; white; vaccinated October 21st, 



TETANUS C3MPLICATING VACCINATION. 187 

with glycerinated virus from a capillary tube. Virus was marked 
**Good until 12-10, 01." Aseptic precautions used before vaccina- 
tion. Symptoms of tetanus appeared November 13th. She grew 
rapidly worse and died November 14th ; duration of illness one day. 

No. 8. — M. W., age 8 years ; white ; vaccinated October 26th, with 
glycerinated virus from a capillary tube marked " Good until 1-5/02." 
Aseptic precautions used before vaccinating. Marked symptoms of 
tetanus appeared November 15th. At this time all local symptoms 
had disappeared. The patient made a complete recovery. 

No. 9. — G. O., age 9 years ; colored ; vaccinated October 26th, with 
dry ivory point. Aseptic precautions used before vaccinating. The 
physician was first called in November 22d, when the patient had 
already been feeling badly for three or four days. The vaccination 
sore was still open and discharging somewhat, but of healthy appear- 
ance. There was an open sore on inside of lower lip. Four days 
later tetanic convulsions set in, and the child died within a few hours. 

No. 10. — A. H., age 13 years; while; vaccinated about three 
weeks previous to the day on which symptoms of tetanus appeared, 
on November 25th. The case was typical and violent from the onset, 
and terminated in death after twenty-four hours. 

No. II.— The official report gives this case also, although the boy 
was never vaccinated. The fact that he was treated within Camden 
and developed tetanus coincidentally with the foregoing, attaches 
to the case considerable interest. 

E, S., age 13 years ; white; residence, boathouse at Mantua, N. J., 
received gun-shot wound on lefl foot November 8th, 1901. The 
family physician dressed the wound. On the nth he was sent to 
Cooper Hospital. Camden, in order to secure more sanitary conditions. 
He remained at the hospital until November 14th. The day he 
returned home symptoms of tetanus appeared, he grew rapidly worse 
and died on November i6th. The duration of illness from tetanus 
was two days. 

The Camden Board of Health immediately appointed the following 
physicians to .constitute the special committee of investigation : 
Doctors Henry H. Davis. Joel W. Fithian and Sylvan C. Bushey. 
These acted in conjunction with the local county physician, of Camden 
County, VV. S. Jones. The work of the committee was to ascertain 
whether all or any of the cases of tetanus were caused either by the 
vaccination or by the vaccine virus employed in the vaccination. The 



l88 MEDICAL SOCIETY OF NEW JERSEY. 

most energetic measures were taken to determine the cause and 
incidentally also the best methods for preventing such outbreaks in the 
future. 

After officially interviewing all the physicians in any manner identi- 
fied with the different cases, the committee decided to investigate the 
nature and purity of the virus emi)loyed. In several instances they 
were able to secure from the physician himself portions of the pack- 
ages from which vaccinations had been made. In every other, instance 
virus bearing the same date was secured from the retail druggist, the 
purchase being made by a secret agent acting for the committee. In 
order to eliminate every possible source of error in the investigation 
samples of all kinds of virus, then being offered in Camden, were also 

secured. 

« 

All these samples were properly tabulated and forwarded to Dr. 
H. O. Baldwin, Princeton, bacteriologist of the New Jersey State 
Board of Health. 

A similar lot of samples was submitted to Doctors Alexander 
Ross and Frederick Fretz, of Cooper Hospital, who tested their 
purity by experiments upon small animals. . The results of the inves- 
tigation were conclusive in showing that in no case was tetanus 
introduced in the acts of scarifying nor through the vaccine virus 
employed. The following evidence was considered in arriving at this 
conclusion : 

The investigation showed that in every instance the usual antisep- 
tic precautions had been taken in the technique of the vaccination. 
In the case of Nos. i, 4 and 9, anQther member of the same family 
was vaccinated at the same time, with the same virus and in the same 
manner. In this other member a typical sore arm with absolutely no 
complications was the result. The first named. No. i, is of especial 
interest, since the other member was vaccinated from the same 
capillary tube as the one who subsequently developed tetanus. No. 
II, which is given space in the report, was never vaccinated at all. 

The bacteriological investigation of the virus employed showed 
the virus pure and entirely free from tetanus bacilli. The experi- 
ments on small animals also shpwed negative results. 

In every instance in which tetanus appeared the vaccine vesicle had 
been broken and the sore irritated by external causes. Without a 
single exception symptoms of tetanus tirst appeared two or three 
weeks after the date of vaccination, and all the fatal cases ran short 



TETANUS COMPLICATING VACCINATION. 1 89 

courses. The period of incubation, of short course tetanus, never 
exceeds a few days and is certainly not longer than ten days. 

In Philadelphia alone nearly half a million persons were vaccinated 
with the same virus without developing this complication. 

During the year at least twenty thousand persons were vaccinated 
in Camden. Of this large number ten persons were found subse- 
quently the victims of tetanus. The vaccinations were responsible 
for the tetanus only in the sense that they produced wounds .which 
were subsequently exposed to the germs of tetanus. 

In the opinion of the committee certain atmospheric conditions, 
for example, a long period of dry weather and high winds, explain the 
outbreak. Because of these conditions, or coincidentally with them, 
germs of tetanus were present in extraordinary abundance. The 
shifting nature of Camden soil enabled the winds to spread the germs 
through the atmosphere to every exposed wound. 

DISCUSSION. 

Dr. DOWLING Benjamin, Camden.— What I have to say on this 
subject is of some practical importance. We had an ample opportu- 
nity of testing the value of certain remedies, during the epidemic, 
among others, tetanus antitoxin. There seems to be no evidence that 
the tetanus antitoxin has any effect. I asked Mr. Mulford (who 
perhaps knows more about this subject than any one else), in the 
presence of a physician, what the laboratory showed in regard to the 
effect of the antitoxin of tetanus upon curing that disease, and he said 
that they used to lose a great many horses, they formerly lost 
thousands of dollars' worth of these animals from tetanus. They 
injected them with tetanus antitoxin when they got tetanus, but it did 
not cure them. He then tried the experiment of using the tetanus 
antitoxin at the time the toxin of tetanus was introduced, and found 
that invariably if the tetanus antitoxin was used at the time that or 
before the tetanus bacillus or the tetanus toxin was introduced, the 
result was invariably a cure or prevention. Since this discovery they 
had lost no more horses. This, I think, is a very important fact. It 
may be that this law holds good with other antitoxins. I would like 
certain experiments made upon three series of guinea pigs with diph- 
theria antitoxin. In one series I would introduce the diphtheria anti- 
toxin at the time of the toxin ; in another I would introduce no 
antitoxin, and in the third series I would introduce it when the 
disease was well developed. 



190 MEDICAL SOCIETY OF NEW JERSEY 

This experiment should be made (as the judges say) *' by one who 
has not already formed or expressed an opinion " in order to be 
disinterested. This would show what effect the antitoxin has in 
curing the disease after it had developed. Possibly the results would 
compare with the observation made by Mr. Mulford governing the action 
of tetanus antitoxin. We certainly know that the use of antitoxin 
of diphtheria late in that disease is of questionable value as shown by 
the Philadelphia municipal hospital reports. One case of tetanus, in 
Camden, got well under the tetanus antitoxin treatment. It was one of 
the slow cases, and it is very doubtful if the antitoxin had any effect. 
I was called in to see a case which had been vaccinated three weeks 
before by a druggist, in which tetanus had developed. It was a most 
malignant case. I cut out the whole infected area deeply down to 
the muscle at once, three inches in diameter and one inch deep, and 
sterilized this area on the theory that possibly the bacilli might be 
there in that wound, and that if I removed this focus there would be 
no more absorption of toxins, and what toxin was in the system I 
could neutralize by enormous doses of antitoxin of tetanus. I injected 
large doses of this antitoxin, but without any effect, the child 
dying in about twenty-four hours. 



A Plea for the Early Diagnosis and Treatment 

OF Cancer of the Womb. 

BY G. H. BALLERAY, M.D., PATERSON. 

There is no more worthy object of pity than a woman slowly dying 
of cancer of the uterus. Tormented with constant pain, which can 
only be alleviated by large doses of morphine ; subject to haemorrhages 
which are rapidly sapping her vitality ; and to a foul smelling 
discharge which renders her an object of disgust to herself and to all 
who come in contact with her, she looks forward to death as the 
only possible relief, and earnestly longs for the repose of the grave. 
Sad, indeed, is the contemplation of such a case, and, when we 
realize that this terrible state of things might have been averted by a 
timely application of the means at our command, our sympathy 
for the woman is not unmixed with a feeling of resentment towards 
those who, either from ignorance or inadvertence, may have contrib- 
uted to bring about this unfortunate condition. That cancer of the 



CANCER OF THE WOMB. I9I 

neck of the womb is a preventable disease, the writer fully believes, 
and cancer of the cervix constitutes fully nine-tenths of all the cases 
of cancer of the uterus. Of the causes of cancer of the body of the 
uterus we know but little. Cancer of the cervix, on the other hand, is 
always the result of degenerative changes resulting from traumatism. 
No traumatism, no cancer.. The writer does not believe that there is a 
genuine case of cancer of the truly virginal cervix on record. In the 
very few cases reported as such, the observer has probably been 
deceived by the statements of a woman who wished to conceal the 
truth. There can be no doubt that of all the forms of traumatism to 
which the cervix is liable the extensive lacerations resulting from 
childbirth are the most common and the most severe. That 
laceration of the cervix predispose to cancer there can be no 
doubt. Competent observers have traced a direct causative 
relation between laceration of the cervix and carcinoma of that portion 
of the uterus. The experience of the writer is entirely in accord with 
these views. In nearly every case of cancer of the cervix in which he 
has met, in which the disease had not advanced so far as to preclude 
the possibility of determining what the previous condition of the cervix 
had been, laceration, often deep and extensive, was found to exist. 
Unfortunately, until within the last few years most of the cases of 
cancer of the uterus referred to the gynaecologist had already reached 
a stage so advanced that frequently the vaginal walls, bladder and 
rectum were involved, and the condition of the cervix prior to the 
development of cancer could not be ascertained. It is reasonable, 
however, to assume that as a laceration was found to exist in nearly 
all the cases of cancer of the cervix examined at an early stage, the 
same lesion would have been found in the cases which presented 
themselves at a later stage had an opportunity been afforded earlier 
to make the necessary observation. 

If we admit that laceration of the cervix predisposes to cancer, it is 
plainly our duty to repair, as early as possible, all lacerations accom- 
panied by ectropion and abrasion of the lips of the os. When the cervix 
is hard and hypertrophied and the edges of the laceration present an 
eroded surface which bends easily, trachelorraphy is not sufficient — 
amputation of the cervix is the proper operation to perform. These 
cases are sometimes mistaken for cases of incipient epithelioma of the 
cervix, but the experienced eye rarely fails to detect the difference 
between the two conditions. I am satisfied, however, that this condi- 



192 MEDICAL SOCIETY OF NEW JERSEY. 

tion of the cervix is often the forerunner of epithelioma — ^^that it places 
the patient on the borderland of cancer — and for that reason I advise 
the removal of the cervix flush with the vagina. The cervix should 
be removed by a double flap incision, the edges of the v^ound 
brought together with silk-woven gut sutures and a glass stem placed 
in the uterus to prevent contraction of the* canal during the process 
of healing. This operation is a bloody one, unless performed with 
great rapidity, but once the stitches are tied the bleeding ceases. The 
final results are exceedingly satisfactory — a perfectly smooth, healthy 
looking surface with a circular os taking the place of the unhealthy, 
torn, abraded cervix. 

The preventive treatment of cancer of the cervix should begin in 
the lying-in room. The os uteri should be allowed to dilate normally. 
When actual rigidity exists, as in old primiparae, measures to bring 
about relaxation of the tissues, without mechanical violence should 
be resorted to. The best of these consists in the use of large, hot 
vaginal douches of sterile water. If the patient is restless and the 
progress of the labor slow, half a grain of morphia hypodermically 
will often relax the tissues surrounding the os in a surprisingly short 
time. By the use of these means a labor which promised to be 
slow and tedious may be changed into a comparatively quick and 
easy one. 

The absurd notion that prevails in regard to the dangers of infec- 
tion of the parturient woman by the use of vaginal douches during 
labor should not deter the practitioner from resorting to this 
measure in cases of rigidity of the os uteri. It can not be denied that 
a dirty practitioner or dirty nurse, using dirty water and a dirty 
syringe, might infect the patient ; but we believe, that if those gentle- 
men who decry the use of douches in general will only learn habits 
of ordinary cleanliness they will be cured of their hydrophobia. 

In cases demanding manual or instrumental delivery the prevention 
of laceration will be best effected by substituting gentleness and skill 
for brute force and stupidity. If, in spite of the exercise of care and 
skill on the part of the accoucheur a laceration of the cervix does 
occur, what is to be done ? All that is necessary to do is to keep the 
patient in bed for four weeks and use large, hot vaginal douches three 
times daily. Ninety per cent, of all recent lacerations of the cervix 
will heal under this treatment. Rest in bed alone is not sufficient, 
but rest combined with thorough cleanliness of the parts will effect a 



CANCER OF THE WOMB. I93 

cure. The surgeon does not expect his wounds to heal if kept in 
contact with decomposing discharges, and why should the obste- 
trician ? As the late Dr. William Grodeu has said : " It is expecting 
a good deal of nature to suppose that she will heal a torn cervix which 
is constantly stuped in a puddle of stinking lochia." 

Should recent lacerations of the cervix be sewed up ? I have never 
attempted this operation for the reason that I have no confidence 
in it. I do not believe that it is possible to bring the parts accurately 
together immediately after labor, and I have no doubt that in the 
•cases reported as successful, the good result occurred in spite of, not 
in consequence of, the operation — the operator claiming the credit 
which properly belonged to nature. In cases attended with profuse 
haemorrhage it is almost impossible, with the meagre facilities at 
•hand in private practice to suture the torn cervix so as to control the 
bleeding — packing the wound with gauze, however, can be practiced, 
-and is usually successful. Next in importance to the preventive 
treatment of cancer of the cervix comes the early diagnosis of the 
disease when once established. Whether cancer affects the cervix 
or body of the uterus there can be no question that an early diagnosis 
gives the patient the only chance of permanent cure by operation. 
Let the general practitioner bear this in mind, for it is he who sees 
the case first, and, upon the promptness and accuracy of his diagnosis 
rests the life of the patient. When cancer of the cervix is limited to 
the portio vaginalis vaginal hysterectomy gives excellent results — many 
of the writer's patients are alive and well five years after the operation. 

When the disease has involved the broad ligaments and pelvic 
glands and the uterus is fixed, or when the vaginal walls are exten- 
sively involved operation is useless and only tends to bring gynaecol- 
ogical surgery into disrepute. In cancer of the body of the uterus 
vaginal hysterectomy should be performed as soon as the diagnosis 
is made. 

If the family physician can be aroused from his lethargy, and 
induced to give to this important lesion the prompt and careful 
attention which it ought to receive, then the radical operation of 
hysterectomy will confer a lasting benefit upon the unfortunate 
victim of this dreadful disease. 



1 3 



194 medical society of new jersey. 

Brain Abscess of Otitic Origin. 

HY WELLS P. EAGLETON. M.D.. NEWARK, N. J. 

Brain abscess of otitic origin is of very rare occurrence. At the 
Newark Eye and Ear Infirmary, during the past twelve years, there 
are recorded but four cases out of a total of 15,493 ear cases treated. 

Such statistics may be deceptive, however, as this affection may 
give few or no symptoms until just before death. Such patients die 
at their houses without a diagnosis being made. From medical 
friends. I know of five cases of death, probably from brain abscess, 
four of which had been treated at different clinics for suppurative 
otitis, without the graver condition being suspected. In two. autopsy 
furnished the diagnosis. 

In an examination of 131 cases of brain abscess (being all that I 
could find reported, or translated into English, during the past four 
and one-half years, from January i, 1898, to date), chronic suppura- 
tion was the cause in 84^, and acute suppuration in 16^. Among the 
acute cases, three (Green and Holt) never had any discharge whatever 
from the ear, the drum membrane not rupturing. Two occurred in 
very young infants, ear trouble not being suspected. 

Among the cases due to chronic otitis, many are reported as having 
had no discharge for several months or years. So long, indeed, that 
in two at least (Preysing and Bacon), the fact of having had a running 
ear at all, had been forgotten, while in one case (Morehouse) thirty 
years had elapsed since any discharge. 

The path of infection is either directly through the tegmen tympany 
the roof of the antrum, along the blood vessels, or through the internal 
ear. Koerner says, that in 42^ of all cases, a fistulous opening 
connecting the diseased bone with the abscess can be found. 
This .statement is rather misleading, however, for in 112 cases exam- 
ined, a sinus is recorded as having been found only in 1 1, or io<|^ ; and 
while such a sinus does doubtless exist, in a very large percentage of 
cases, it is more microscopical than macroscopical. It is, therefore, 
but infrequently of advantage in operating. 

The inner ear is the path of infection, in a very large majority of 
the abscesses of the cerebellum. (Okada). This has not received the 
attention that it deserves. It is recorded as having been the route 
in 10 of 43, or 23!^, of the cases reviewed, and as in a very large 



BRAIN ABSCESS OF OTITIC ORIGIN. I95 

number no route of infection is given, and no mention made of the 
inner ear having been carefully examined, it is safe to infer that this 
percentage is entirely too low. 

Of the 131 cases examined, 78, or 60^, were situated in the cerebrum 
50, or 38^^, in the cerebellum, and 3, or 2j^, in both the cerebral and 
cerebellum. Of the cerebral, 72, or 92^^, were situated in the tempero- 
spenoidal lobe, 2, or 2^%, in the frontal and 4, or 5^, in the occipital. 

Brain abscesses are generally single, but a second is far from 
infrequent, while three, and even four (Holt) are reported. Abscesses 
of the cerebellum, for some reason, are especially apt to be multiple 
(Ballahce). Of 114 cases examined, 19, or i6f^, were multiple. Not 
recognizing the frequency of more than one point of suppuration, 
has been responsible for many of the failures in operating. One ab- 
scess having been found and successfully drained, the attention of the 
surgeon has been directed to other parts, such as the sinus, when in 
realitv, the cause of the trouble still remained within the brain sub- 
stance itself. 

Acute abscess of the brain may extend so rapidly as to quickly 
overpower the patient. This occurred in a case of Richards, in which 
a man discharged from a hospital, apparently cured of an acute otitis^ 
became demented and within a few hours was brought back in an 
unconscious condition. A large proportion of cases are chronic in 

» 

their nature, however, developing very slowly, often remaining 
quiescent for months or even years, and giving few or no symptoms. 

In one case (McKernon) the only symptom for several years, was 
pain in the head, over what later proved to be the site of an abscess ; 
another had convulsive movements of the face for six months before 
other symptoms appeared (Ropke); while in another severe neuralgia 
of a molar tooth, was the only symptom for a long time, and later, 
after the abscess had been evacuated, each dressing caused a return 
of the same pain (Marsh). 

When chronic, the abscess is surrounded by a capsule which may 
be tough and dense ; in one, case (Blake) being one-sixth and in 
another (Knapp), one-fifth inch thick. The pus in the capsule may be 
viscid. In one case (Bacon) it had almost the thickness of chewing 
gum ; and in another (Manessa) it was necessary to use a curette to 
remove it. The brain tissue surrounding is occasionally the seat of 
multiple hemorrhages, or the abscess cavity may be filled with blood,, 
which may be the cause of the rapid development of the symptom. 
(Ropke and Preysing). 



\(f> MEDICAL SOCIETY OF NEW JERSEV. 

There may be no symptoms until sudden c'eath from rup.ure. 
In an unreported case, under the care of a physician friend, the 
patient was going around the wards of a general hospital, only com- 
plaining now and then of slight headache, when suddenly he expired. 
The autopsy showed a ruptured cerebral abscess. In another case an 
irregular pulse was the only symptom (Passau and Collins). While 
in another, no symptoms whatever were present. (Paquet and Collins). 
Of course in such cases, diagnosis is impossible. Among infants 
slight fever, and gradual loss of flesh, have been the only symptoms 
noted (Holt). 

From such mild symptoms, up to exact localization of the site of 
the abscess, all grades occur; at least sixty different symptoms having 
been recorded. (Marsh). 

The so-called localizing symptoms are unreliable, outside of aphasia, 
which was present in 21 out of 71, or 30^ of the cases, and a pro- 
gressive motor paralysis. 

Treatment. — There is but one treatment,— surgical intervention. 
A few patients have recovered by spontaneous rupture, as happened 
in a case reported by Muck, in which a cerebellar abscess, which 
had given no symptoms, was drained through an incision in the 
skin, with the idea that it was simply a subperiosteal abscess. And 
Randall case, in which, while dressing what was apparently a simple 
mastoid case, a cerebellar abscess ruptured into the wound. 

When to Operate. — Case i. Male, age 34, had running ear for fifteen years. 
When first seen on the tentli day of attack, temperature 100°, pulse 54, severe 
dizziness, intense pain in occiput, occasional vomiting, double optic neuritis. 
Had been delirious previous night. No tenderness over mastoid.^ No discharge 
Irom ear. Diagnosis : Cerebellar abscess. Ordered to Eye and Ear Infirmary 
for operation, where he arrived in good condition, walking alone from the 
carriage up two flights of stairs only needing something to catch hold of on 
account of the dizziness. Operation appointed for next day. Less than four 
hours afier admission, suddenly became maniacal, had a convulsion, and expired 
in a few minutes. The abscess had ruptured. 

This case answers the question when to operate. Immediately the 
diagnosis is inade. 

In the examination of the 131 cases, seven similar experiences are 
reported, in which the only chance for the patient's recovery was 
lost by delay. In all of them a diagnosis of probable brain abscess 
hafl been made ; four were in hospitals at the time of rupture, and 
for two of them, operation had been placed for the following day. 



BRAIN ABSCESS OF OTITIC ORIGIN. I97 

It has been said, that if rupture is so imminent, it is almost sure 
to occur on the operating table. Undoubtedly so ; and while the 
probability of a fatal outcome is great, there always remains the pos- 
sibility, that if operated on immediately, rupture may not occur, and 
even if it does, the other possibility exists of successfully draining the 
ruptured abscess, the patient being kept alive in the meantime by 
artificial respiration. More than one such case is reported. In 
Waterhouse case, under partial anaesthesia, respiration stopped, and 
pulse became imperceptible, both immediately began again as soon 
as the abscess was drained. In operating, the fact that the operation 
is entirely explorative, in the vast majority of cases, is to be constantly 
kept in mind. Experience proves that cerebral localization in brain 
abscess has, excepting in rare cases, been of too little value to admit 
of a positive diagnosis of the site of the abscess, early enough to 
promise good results from operating (Hammond). 

That the opening of the dura is entirely explorative is shown by 
the fact that in 10 out of loi cases reviewed, the wrong fossa was 
first explored, inasmuch as in about 10^ of all the cases operated 
on, the symptoms caused the surgeon to suspect the cerebrum to be 
affected, when, in reality, the suppuration was in the cerebellum or 
vice versa. Mistakes are possible by the presence of symptoms 
which, while apt to be regarded as localizing, are due to increase of 
pressure at a point, perhaps, far removed from the site of the actual 
suppuration. Of the cerebellar abscesses. 13 out of 41, or 31!^, gave 
symptoms such as paresis, paralysis, or rigidity of the eye, arm, hand 
or leg, which may have caused the surgeon to suspect the cerebrum 
of being the seat of the lesion. 

Out of loi cases operated on, failure tolocate the pus on exploration, 
is recorded in 22^. These failures were due to the pus being so 
thick that it could not be drawn through any aspirating needle, or 
the capsule was tough enough to resist the passage of the exploring 
instrument. In several of the failures the post-mortem showed the 
exploring needle to have passed through the abscess cavity several 
times without revealing the pus. In one, not only a director, but also 
a forceps had entered the abscess, and this in an abscess one and one- 
quarter by three-quarter inch in size. In another, in which a probe 
was used, the whole abscess, in its capsule, was pushed in front of 
the probe. And in a third, a trocar and cannula struck something, 
which on account of its hardness, was thought to be a solid tiimor, 



198 MEDICAL SOCIETY OF NEW JERSEY. 

but which the post-mortem showed to be an encapsulated abscess. 

In view of these facts, it would seem that having failed to locate the 
abscess, after a faithful search with a knife, the surgeon is justified in 
passing his finger into the brain substance, as occurred in Waggett's 
. case, in which after having searched both the cerebellum and cere- 
brum, each in ten different directions, the symptoms continuing, he 
introduced his finger, and located the abscess. The patient recovered. 

The only ill effect recorded, as the direct result of exploration, was 
one case of word deafness, which subsequently disappeared (Waggett). 

A ventricle was opened in three cases without any bad result 
( Deuch, Manasse Kirkland). 

Case 2. — T. J., age 56. Acute otitis. Six weeks previous symptoms of 
mastoid involvement. Operated. Perisinus abscess found. Sinus not opened. 
Did well for eight days, but headache when moved head. Then irregular vomit- 
ing, and occasional subnormal temperature. Later, rapid loss of flesh, and 
drowsiness, which gradually became semi-coma. Operated again on twelfth 
day. Thrombosis lateral sinus found and evacuated. Next day deep coma. 
Without an anajsthetic, a cerebellar abscess was evacuated, through the opening 
made in the bone on the previous day. Relief instantaneous. The patient, 
who had not spoken for two days, and who, during twenty-four hours had been 
in deep coma, opened his eyes and became entirely rational. Did well for three 
days, but abscess did not drain well, because of small size of opening. Fourth 
day, chill and high temperature, which next day being repeated, internal jugular 
ligated. No clot found. Death ten hours later. 

The case is interesting, chiefly because of the mistakes made, which 
probably cost the patient his life ; the most important being the 
failure to drain the abscess by a sufficiently large opening on the day 
that the thrombus was removed, and later, in allowing the chills 
and high temperature to direct attention away from the brain itself. 

Results — Koerner, in 1901, collected reports of 267 operations of 
brain abscess, of which 51^^ recovered. Of the 131 cases examined 
by me, the dura was opened, and the brain explored in loi, or 'j^ffo, 
with the recovery of 43, or 42^^. The dura was not opened in 12, 
or 9^/. all, of course, dying; and the remaining 18, or 14^, were not 
operated on at all. 

Hlake— "Lancet," March 31. 1900, p. 439. 

Ballance— Otol. Soc, Februarys, 1900. 

Barr — "(Glasgow Med. Jour." Vol. LlII, 1900, p. 400. 

Bacon — Am. Otol. Soc. Trans , May i. 1900. 

Bell— "Ann. Otol. Rhin. Lary." Vol. VII, 1898. p. 29 



BRAIN ABSCESS OF OTITIC ORIGIN. I99 

Bevens— "Ann. Otol. Rhin. Lary." Vol. VII, 1898, p. 49. 

Biggs— "Medical Record," February 16, 1901. 

Bougie — "La Presse Med." August 7, 1900. 

Bonam — " Revue de Laryn," d'Otol et de Rhin. 

Collins— "Am. Jour. Med. Sciences." Vol. CXVII, 1899, p. 439. 

Coe— "Arch. Otol." Vol. XXVII, 1898, p.. 237. 

Costenia — "Laryn," February, 1901, p. 135. 

Crombie — "Medical Record," May 27, 1899, p. 769, 

Deuch— Am. Otol. Soc. Trans., 1901. 

"Arch. Otol." Vol. XXVII, 1898, p. 247. 
"Arch. Otol." No. i, Vol. XXXI, February. 1902. p. 42. 
Am. Otol. Soc. Trans.., May, 1900. 
DeSanti— "Jour, of L. R. & O." May, 1902, p. 268. 
Donald — "Glasgow Med. Jour." Vol. LlII, 1900, p 45. 
Dunlefoy — "La Presse Med." January 27, 1900. 
Dudley— "Laryn." No. 4, Vol. IX, p. 259. 
Grant & Hallance— "Arch. Otol." No. i, Vol. XXXI, p. 19. 
Grant— "J. L. R. & O." October, 1901. 
Gardiner — "Medical Record," August 5, 1901, p. 171. 
Greene — "J. A. Ass." 1899, p. 1187. 

"Am. Jour. Med. Sciences," Vol. CXVH, April, 1899, p. 406. 
".^rch. of." June 28, 1900. 
Grunet & Zaroni—" Arch, of." June 28, 1900. 

"J. L. R. & O." August I, 1900. 
Grulning— "Arch. Otol." No. i, Vol. XXIX, February, 1900, p. 53. 

Am. Otol. Soc. 1898, p. 36, 
Hartman— "J. of R. & O." 

Haushey — Austrian Otol. Soc, March, 1899. and February 28, 1899. 
Hayden— "B. M. J." March 21, 1896. 
Herman — 1898. 

Holt— "Pamphlet Am. Ped. Soc." Washington, Mays, ^897. 
Jack — "Boston Med. and Surg. Jour." December 26, 1901, p. 699. 
Jenkins — "Lancet," March 30, 1901. 
Jones — "J. of L. R. & O." May, 1902, p. 260. 
Knapp— "Arch. Otol." No. i, Vol. XXIX. 
"Arch. Otol." Vol. XXXT, p. 999. 
Kirtland — "Aust. Med. Gaz." July 20, 1898, p. 303. 
Koch— "Ann, Otol. R & L." Vol. VlII, 1898, pp. 33. 465 and 625. 
Roller — "Medical Record," January 19, 1901, p. 87. 
Korner — Ott. Erk. des Hirns. Hirnhaute, 1902. 
Kummel-"Arch. of Otol." Vol. XXVII. 1898, p. 135, &c. 
Lewis — "Medical Record," March, 1902, 
Lindt— "Arch, of Otol." No. 18, 1899. 

McConochie — "Maryland Med. Jour." Vol. IXL, 1899, p. 186. 
McKernon— "N. Y. E. & E. I. Repts." Vol. VI, 1898, p. no. 

"Arch, of Otol." Vol. XXVII, 1898, p. 214. 

"Arch, of Otol." No. i. Vol. XXXI. February, 1902, p. 45. 

"Am. L. R. & O. ' May 23 to 25, 1901, p. 272. 

"Ann. Otol. R. & L." No. 2, Vol. XI, May, 1902, p. 178. 
Marsh — "Briiish Med. Jour." April 30, 1898, p. 1128. 
May— "Arch, of Otol." Vol. XXIX, p. 42. 



200 MEDICAL SOCIETY OF NEW JERSEY. 

Manasse— "Arch of Otol. ' Vol. XXVII, 1898, p. 115. 

Maynard — ''Ind Med, Gaz." August 1899. 

Maguire — "British Med. Jour." No. i, 1895. 

Miles & Shen nan— "Lancet," April 20, 1899, p. 1143. 

Milbury— "Medical." Vol. XVI. April 1898. p. 649. 

Milligan— "Medical Chronicle," Vol. X. 1898-1899, p. 245. 

Mort— "Arch Otol." Vol. XXVI, 1897, p. 297. 

Morehead — "Phila. Med. Soc." 1900, p 959. 

Muck & Korner— "Arch. Otol." Vol. XXIX, August, 1900, p. 300. 

Nicoll— "Glasgow Med. Jour." Vol. LI, 1899. p. 56. 

Okada, W. — "Diag. und Chir, des Otog. Klein hirnabscesses," 190a. 

Passau — "Arch. Otol." February, 1901. 

Phelps— "N. Y. Med. Jour. ' No. 70, July 8, 1899, p. 65. 

Preysing— 'Arch. Otol." Vol. XXX. p. 25. 

"Arch Otol." Vol. XXX, April. 1901. p. 127. 
Phillips— "Arch. Otol." Vol. XXX. p. 85. 
Randall — "J. A. M. Ass." November 11, 1899, P* 1185. 
Richards — "Boston Med. and Surg. Jour." August 16, 1900. 

"Arch. Otol." No. 3, Vol. XXX. p. 129. 
Richardson — "Jour. Med. Ass." Chicago, February 23, 1901, p. 493. 

"British Med. Jour." October 20, 1900, p. 1191. 
Ryerson — "Canadian Med. Review," Vol. VI, 1897. p. 185. 
Ropke— "Arch. Otol.' Vol. XXX. p. 30. 
Ruth — "Medical Record," May 17. 1932 
Seligman— "Arch, of Otol." Vol. XXVII f, p. 256, 
Stenger— "Arch, of Otol." No. i. Vol. XXXf. February, 1902, p. 67. 
Sheppard — "Am. L. R. & O." 7th Annual, 1901. 
Stites (Ballance)— "J. of L. R. & O." 
Thigpen (Seely)—" Arch, of Otol." Vol. XXVI, p. 256. 
Waggett — "British Med. Jour." October 14, 1899, p. 1000. 
Waterhouse — "Lancet," March 30, 1901. 

Woodward — "N. Y. Med. Jour." No. 67, June 11, 1898, p. 822. 
Woods— "Tr. Royal Acad. Med. of Ireland." Vol. XVI, 1898. p. 133. 

DISCUSSION. 

Dr. W. B Johnson, Paterson. — The author is to be congratulated 
on his courage in presenting the histories of these cases to the Society. 
The paper is instructive, and shows that a wider range of operations 
of this kind will in the future be carried out. It is only recently that 
these cases have begun to show such marked improvement in the 
results. These cases used to terminate fatally in almost every in- 
stance. The Doctor's recommendation in relation to fearlessness of 
operating and the continuation of the operation to the point of com- 
pletion is one of vital importance. Many of these unfortunate cases 
have certainly not been reported, and if all were reported I think the 
percentage of recoveries would be distinctly less than appears from 
the statistics now available. Recently not only these cases of brain 



BRAIN ABSCESS OF OTITIC ORIGIN. 201 

abscesses, but also the cases of sinus thrombosis with extensive opera- 
tion and jugular ligation, have been reported as yielding favorable re- 
sults. Dr. Fred. Whiting and Dr. J. F. McKernon, of New York City, 
have reported cases of that character, and it is interesting to note that 
these cases are now amenable to treatment and cure. Regarding the 
matter of early operation. I think that the same hour that it is posi- 
tively determined that a person has cerebral or cerebellar abscess the 
operation should be done. There are a few exceptions in which rup- 
ture of such abscesses has occurred before operation, and the patients 
have recovered, but almost invariably death occurs unless the opera- 
tion is done prior to rupture and general cerebral infection. The 
difficulty of recognizing the symptoms is such that when the symptoms 
seem to indicate clearly the presence of brain abscess we should pro- 
ceed at once. I have in mind cases which at autopsy showed tremen- 
dous quantities of pus in the cerebral cavity, either in the form of 
abscess or general purulent inflammation. I recall a case in which 
there was an almost total absence of any symptoms indicating such 
extensive lesions. I think the thanks of the Society are due the 
author. 

Dr. T. R. Chambers, Jersey City.— I wish to congratulate the 
author on his paper, and the Society on receiving such a progressive 
paper. I wish to emphasize the fact that immediately upon making 
the diagnosis, operation should not be delayed one minute, for 1 have^ 
had an experience similar to that of Dr. Eagleton. Within three 
weeks I had a case in which operation was to be done the next day, 
but the patient died during the night. With regard to the treatment. 
I would say that the balance of opinion seems to be in favor of thrusting 
a knife into the brain where abscess is suspected rather than 
resorting to the use of the aspirator. This can hardly be designated 
as fearlessness, because the surgeon is really only doing his duty, and 
is endeavoring to secure free drainage for pus. 



Supplementary Notes on Abortion of Mastoidii is. 

BV TALBOT R. CHAMBERS, M D., JERSEY CI 1 Y, N. J. 

One approaches this subject with hesitancy, because so much has 
been written on it, and such positive views are held by men of 
authority. 



202 MEDICAL SOCIETY OF NEW JERSEY. 

Dr. E. j. Bernstein, of Baltimore, concludes a monograph as follows : 

" First, that in acute middle ear inflammation, the pathological 
changes are nearly always spread over the entire mucous membrane. 
Politzer and Bruhl, even in those cases where no symptoms of 
mastoid irritation could be made out, found pus in the antrum and 
mastoid cells on the post-mortem table. Secondly, that with this 
knowledge and the recognition of the normal histology it seems in- 
credible to even talk of aborting a mastoiditis." 

Yet I feel for several reasons that my position is well taken, namely, 
that properly douching the middle ear for ten minutes at a seance, 
repeated as many times as may be necessary, with water at a temper- 
ature of 120"* F. will, if continued for several days, abort otitis media 
purulenta and inflammation of surrounding parts, particularly acute 
mastoiditis or exacerbations of chronic mastoiditis. It is of course 
understood that the character of the infection be known before prog- 
nosis be made. For instance, if pneumococci (Frankel) be the germ, 
absolute cure will surely result immediately, provided a peptic enzyme 
be employed. If other germs be present 1-4000 bichloirde solution, 
temperature 120^ F. will very speedily, in most cases, bring the parts 
to a state of rest. There are some cases where granulations and 
necrosed bone are present in the middle ear or mastoid. Here local 
surgical interference is called for, and no treatment would avail 
without it. If successful, no further treatment is called for when 
the dressing is removed. In case there be any discharge from the 
ear the hot water douche is most distinctly indicated. 

Such was my recommendation three years ago and again each year, 
in papers read before the American Medical and the New Jersey State 
Associations. 

There are two things to notice; one will be unable to guess that the 
water is 120° F. and hence a bath thermometer is necessary, and I 
find a cheap instrument on sale for ten cents which answers very well 
for this purpose. 

Secondly, the return ear douche is absolutely necessary, or the skin 
of the face would be burned by water at this temperature ; as it is, 
some cases show marked sensitiveness in the canal after the douche 
has been employed a day or two. One old man had a terrible der- 
matitis of the ear lobes. They were blistered and immensely swollen. 
Another, whose ear had several years previously been frozen, suffered 
with an ear swollen to three times its natural size. I am not sure but 



ABORTION OF MASTOIDITIS. 203 

this swelling was due to the simple pressure of a bandage after a 
Schwartz-Stack operation had been done. All pressure was taken 
from the ear and the dressings were held in place by adhesive plaster 
after the second day. This swelling had been ascribed to the hot 
douche, but I feel confident it was a case oi post hoc non propter hoc. 

During the past year I have met with several cases in which, not- 
withstanding the 120^ F. douche, mastoid inflammation went on to 
operation, but they were so exceptional that to-day I feel this treat- 
ment is the best, safest and surest in middle ear and mastoid inflam- 
mations. One very good criterion is the reports which come to me 
from general practitioners who refer such cases to me and who 
do me the honor to have me operate for them when necessary. It has 
been said to me on a number of occasions by different practitioners, 
"Your 120** F. douche deprived you of another mastoid operation.'* 

In order to show results from this treatment in the hands of others, 
I append a few letters and expressions received by me. 

Dr. R. B. Gilman, of Jersey City. — " In reply to yours asking for 
notes on the use of hot water 120 degrees in mastoid diseases, I must 
acknowledge that I have no notes and must rely upon my memory 
wholly.. The most interesting case was that of Mr. P. The treat- 
ment ordered included the use of hot water douches 120 degrees, but 
he could only bear 1 10 degrees, and that was the highest temperature 
«sed. So says the sister who cared for him. Mr. A. used a douche 
at 120 degrees with good effect. In all the cases where I have 
ordered the douche at 120, failure to use a temperature above no 
has been the rule, and if there were exceptions I fail to recall them." 
(Both his cases (Mr. P. and Mr. A.) recovered without mastoid oper- 
ation, though both had constitutional and local syrrtptoms of the 
disease. Mr. A. had paracentesis tympani done.) 

Dr. D. S. Hardenberg regularly orders the douche as hot as can 
be borne through the return outflow. He has seen mastoid aborted 
by it, and in certainly twenty cases the discharge has been stopped. 
He generally uses boracic acid in the douche. Dr. James Hoffman 
has record of three cases of mastoiditis aborted by the 120 degree ear 
douche. 

Dr. F. E. Lambert feels sure he has seen positive abortion of 
mastoiditis which threatened necessity for operation in one dozen 
•cases. 

Dr. J. W. Macmillan. — " I well remember two cases I was about 



204 MEDICAL SOCIETY OF NEW JERSEY. 

to consign to you for mastoid operation when improvement under the 
use of the hot water douching (and internal remedies) cheated you 
out of the cases." 

Dr. W. F. Radue, says. — I wish to inform you of the good results 
I had with the hot douche at 120 F. in acute otitis media and other 
painful affections of the ear. As you know, my child had an acute otitis. 
I used the douche as directed by you at 120 F. and in twenty-four hours 
the pain and swelling was much improved. I continued the douche 
five days longer when the ear was well, excepting a slight watery dis- 
charge which let up with a few days' use of boric acid solution. I 
also desire to mention four other cases I treated by the douche. 
Three of acute otitis media. They were given the hot water douche 
at 120 F. four times a day. In twenty-four hours the pain and 
swelling was much better and in a week were all well. In one case, 
a chronic otitis, with very bad smelling discharge, I ordered the hot 
salt water douche three times a day for a week. After that I ordered 
a douche every morning, to be followed by drying the canal and to- 
soak a small piece of cotton with a fifty per cent, enzymol, to be put 
into the canal. This was continued for about two weeks when all 
discharge was gone, except a little watery discharge which got well 
under dry boric acid. I find after using enzymol for a time that there 
is still an excessive moisture in the canal which can be much 
improved by a few days' use of boric acid solution. The canal gets 
dry and the hearing improves very much. I find it so in my own case 
in particular." 

Dr. George H. Sexsmith, of Bayonne. — *' I have seen a number of 
cases of mastoiditis where operation seemed necessary, relieved by 
this 120 degree hot water douching. I call to mind three cases: 
Mrs. C. started in with fever and terrible pain. Morphine was exhib- 
ited. The hot douching was used hourly for six hours. The tender- 
ness of the mastoid disappeared, and the case was practically cured 
in fifty-six hours." 

2d. A boy with temperature 102 degrees and deaf, with a mastoid 
tender for four days and the temperature rising to 105 degrees. The 
hot water douche relieved the pain in twelve hours and he was well 
in eighteen hours. 

A girl two and a half years old, terrific earache, mastoid swollen 
and painful. The child had to be held by main force on beginning 
the hot water ear douche, but after the first time was very glad ta 
have it repeated, and she was speedily cured." 



ABORTION OF MASTOIDITIS. 205 

Dr. E. T. Steadman, of Hoboken. — " I would state that in the 
case of a child, age two years, I have used it with good success. 
The child haJ no suppuration, but pain and redness over the mastoid 
with some swelling." 

Dr. Walter Steadman.—" I take great pleasure in forwarding 
reports of three cases of suppurative otitis cured with the hot douche. 

Case I. — A boy of seven years of age, having just recovered from 
scarlet fever, was taken with intense earache and fever. 1 saw the 
child the following day, finding temperature 102, pulse 100. The 
tissues around the right ear very tender, and a purulent discharge of a 
very strong odor. I used the douche about 120 degrees F., three 
times a day, and cleansed out canal with fifty per cent, solution of 
cnzymol. In three days I noted a marked improvement in discharge, 
and at the end of ten days the trouble had entirely subsided. 

Case 2.— A girl four years of age had, following measles, a purulent 
discharge from left ear, which had been treated by a physician in town 
for two weeks by syringing out with borax water, and no improve- 
ment. I put her on iron, and used the hot douches three times a day, 
followed by the use of eVizymol, with a complete recovery in ten days. 

Case J. — Girl ten months old, had a purulent otitis of both ears' 
following diphtheria, profuse discharge with strong odor and excoria- 
tions of ears from discharge. This case was treated like the other 
two, with hot douching, but did not use the enzymol. And although 
it took four weeks to conquer, the child has fully recovered and hears 
very well." 

Dr. Hamilton Vreeland. — "I have used hot douching in perhaps 
six or seven cases. One of mastoid, with good results in every 
instance. Previous to using the recurrent bulb (return outflow) I have 
used hot water at about 1 10^ poured into the ear out of an orange 
spoon, but find this new treatment very much better." 

Dr. O. R. Blanchard, Jersey City. — "Since using the hot douche 
for a near relative, and seeing ils success, I now always order the 120 
hot douche for ear or mastoid inflammation with continued success." 

Dr. Henry Spence, Jersey City. — " I have in mind one case of 
double ear discharge, and one case with one ear running, which were 
speedily aborted by the use of the 120 hot water douche. In fact I 
have frequently seen very happy results from its employment in 
relieving pain and stopping discharge ; I have not had a single mastoid 
calling for operation since beginning its use, and I had a number 
previously." 



2o6 MEDICAL SOCIETY OF NEW JERSEY. 

DISCUSSION. 

Dr. W. B. Johnson, Paterson.— I follow Dr. Chambers in so far 
as the treatment and relief of otitis media purulenta acuta goes, and 
I will not dispute with him as to whether the temperature should be 
120*^ F. or not, though I may say that some of my patients object to 
this temperature, even though the water does not flpw out upon the 
face. But when one reaches the point of curing mastoid disease by 
the application of this douche, and endeavors to substantiate this 
position by diagnosis of the ordinary run of physicians, I must say 
that I doubt the correctness of the diagnosis as to the number of 
cases of mastoid disease. I question even whether mastoid disease, 
once started can be cured by any treatment which does not come any 
nearer to it than the drum membrane. Again, there has been of late 
a general opinion that the application of heat has a tendency to 
increase the bacterial energy of an inflammation located in this part 
of the body, though I am frank to say that I am not personally 
entirely in accord with that view, and use hot external applications in 
the early stage of what is called mastoid disease. But I do not 
believe it is true mastoid disease simply because there is a certain 
amount of pain and tenderness in the mastoid region, with inflam- 
mation of the inner ear, and a certain amount of fever. When an 
inflammatory trouble occurs in a closed cavity, and the mastoid cells 
constitute such a cavity after the inflammation has occurred and 
empyema exists, I do not believe it is a common thing for recovery 
to take place, either as a result of internal medication or the appli- 
cation of heat or cold or anything else. I doubt if the inflammatory 
trouble should be really called mastoiditis, even though there may be 
some slight swelling over the mastoid process. As to the question of 
which particular bacterium is present, I agree thoroughly with Dr. 
Chambers. If the case is one of pneumococcus infection the inflam- 
matory symptoms are more likely to subside, even though no hot 
water be used ; if the infection is due to the streptococcus, then the 
chance of recovery without further trouble is not so good. Whether 
or not it is safe for us to select a large number of cases reported to 
us by letters, founded on more or less indefinite notes, and call them 
cases of mastoiditis, is very doubtful in my opinion. I do not think 
many of them would have gone on to mastoiditis even if this par- 
ticular treatment had not been adopted. 1 do not say this in criticism 
of the method of treatment, because I believe that in acute otitis it is 



ABORTION OF MASTOIDITIS. 20/ 

valuable, but I do not think the clainn that it is very useful in the 
treatment of true mastoiditis can be substantiated. 

Dr. N. L. Wilson, Elizabeth.— Dr. Chambers is to be congrat- 
ulated for his persistency in presenting this subject to this Society, 
and also insisting that this treatment will abort mastoiditis. Where 
there is acute congestion in the antrum, or perhaps extending into- 
some of the mastoid cells, the condition can be sometimes aborted, 
but I have never known this favorable result to occur where pus was 
present in the mastoid cells. I recall a case occurring last winter, in 
which I endeavored to abort a mastoiditis of the pneumococcus 
variety in a nurse. On one side it went on to the formation of pus,, 
while on the other it was only a congestive state. The first required 
a mastoid operation, while the second was cured without it. It is 
often difficult, as Dr. Johnson says, to get the patient to submit ta 
water at a temperature of 1 20*'F., and I believe Dr. Chambers has 
changed his views on this subject, because, if I recollect correctly. 
Dr. Chambers, in his first paper, recommended a temperature of 
i3o°F. This is pretty hot, and I have found it difficult to make use 
of water at 115^ or even iio^'F. I should not like the statement to 
go out from this Society, that heat can abort the condition after pus 
had once formed in the mastoid cells. 

Dr. Cornelius Shepherd, Trenton. — I have been deeply inter- 
ested in this paper. Those who have discussed it have somewhat 
mystified me. The hot applications are not supposed to relieve 
after abscess has formed, but it cuts short or prevents the process of 
the formation of abscess. This is like tonsillitis, you may have a 
pretty severe attack of tonsillitis without suppuration ; it subsides or 
aborts short of suppuration. 

Dr. Chambers.— Dr. Johnson says that these doctors who sent in 
reports of mastoid cases were perhaps mistaken in the diagnosis. I 
will say that I saw many of these cases myself, and know that they 
were mastoid cases, but I do not know, and do not know any one else 
who can tell, whether the stage of suppuration has actually been 
reached. It has gone on, as Dr. Shepherd says, to a stage very close 
to pus formation. I never claimed that a temperature of 130*^ should 
be used; I originally advised that the temperature should be I25*'F., 
and I assert that with few exceptions a temperature of 120** can be 
used if the water is applied properly with the return current appar- 
atus. It will abort in its incipiency many cases of mastoiditis and 
acute otitis media, I am sure. 



20s medical society of new jersey. 

Exhibition of a New Obstetrical Forceps. 

BY DOWLING BENJAMIN, M.D., CAMDEN, N. J. 

I hold in my hand the forceps of Dr Hodge. It is one of the 
most celebrated and extensively used of obstetric forceps. They 
have the advantage of a long handle, and the hooks on the handles 
are useful in some instances, particularly in breech presentations. 
The Simpson forceps, which I now show you, came gradually into 
use in Europe and America, and is to-day, perhaps, more generally 
used than any other. This statement is made on the authority of the 
instrument makers. The popularity of this instrument is partly due 
to the ease with which they may be applied. Another reason is that 
they do not slip so easily as the Hodge. You will notice that the 
blades of the Simpson instrument do not come nearly so close together 
as those of the Hodge instrument — in other words, the cephalic curve 
is greater in the Simpson forceps. For the same reason the Simpson 
forceps do not allow of so much compression of the child's head. 
One must compress very hard with the Hodge forceps, and even then 
you will find that they slip because of the shape of the blades. The 
Wallace forceps has the same cephalic curve as the Hodge, but the 
pelvic curve is more marked. The Simpson forceps has a very slight 
pelvic curve, and hence if they should slip they would not do so much 
damage. I carried the Hodge forceps for a long time because of 
its long handles and hooks, and I also carried the Simpson because of 
the advantages which I have said it possesses. I then endeavored to 
eliminate the disadvantages of the Simpson and Hodge instruments, 
and combine their advantages in one instrument. In the first place, I 
adopted the lock used on the Simpson instrument, and also adopted 
both the cephalic and the pelvic curves of the Simpson instrument. I 
adopted the handles of the Hodge forceps, lengthening the shank a 
little. I was once called in consultation to a case in which the child's 
head had already been pulled off and the perineum torn into the rec- 
tum, and one arm of the child had come down and had also been 
pulled off. I had been called with the idea of having me perform a 
Caesarian section. The woman was not in condition for this opera- 
tion, being exhausted and already septic. I finally succeeded in 
reaching the sound shoulder and delivered the child by the natural 
passages. I never could have done this if I had not had the forceps 
with the hook and Hodge handles. 



CURE OF GASTROPTOSIS. 209 

Here is a large, cumbersome and complicated Tarnier forceps for 
axis traction. I desire to show you a simple hahdle, which when ap- 
plied to the handle of my forceps, enables me to convert it, or any 
other forceps, into an axis traction instrument. 



The Surgical Elevation of the Stomach for 

THE Cure of Gastroptosis. 

BY HENRY D. BEYEA. M.D., PHILADELPHIA, PA. 

ASSOCIATE SURGEON, GYN^CEAN HOSPITAL ; ASSISTANT GYNAECOLOGIST, 

UNIVERSITY HOSPITAL; INSTRUCTOR IN GYNAECOLOGY, 

UNIVERSITY PENNSYLVANIA. 

Before entering upon the consideration of the surgical treatment of 
gastroptosis, the subject proper of my remarks, it is necessary that I 
briefly call your attention to the frequency, symptomatology, and 
medical and mechanical treatment of this physical condition. 

Gastroptosis, the falling or descent of the stomach to a more or less 
vertical position, existing alone or in association with a similar 
descent of one or more of the other abdominal organs, (Glenard's 
disease), has been known to the profession since 1885. Only during 
ths last eight or ten years, however, have any accurate studies of its 
frequency and causative influence in the production of symptoms of 
importance been made. 

Taking the aspect of our present knowledge, gastroptosis may be 
said to be a very frequent cause of chronic invalidism, particularly in 
women, and a subject of daily interest to the specialist in the diseases 
of the stomach and the practitioner of internal medicine. The fre- 
quency may be estimated from the recent publication of Steele and 
Francine, that sixty-three cases of gastroptosis were observed and 
treated during the last two years in one service of the medical dispen- 
sary of,the University Hospital. 

7"-^^ ^^w.v^j of gastroptosis, like floating kidney, are not definitely 
known, but the descent of the stomach is attributed to tight lacing, ci>. 

changes in the intra-abdominal pressure, as in relaxation and dias- 
tasis of the recti muscles, or it is said to be a congenital condition. 

Position. — The upper curvature of the stomach, through inflation 
by means of the stomach tube and auscultation percussion, is outlined 
in the more pronounced cases midway between the zyphoid cartilage 
and umbilicus, at, or one or two inches below* the umbilicus. The 

14 



2IO MEDICAL SOCIETY OF NEW JERSEY. 

supporting ligaments of the stomach, the gastro-hepatic ligament or 
omentum, and gastro-phrenic ligament, are stretched out or length- 
ened. As a result of the ptosis there is often an associated dilitation 
of the stomach. 

The symptoms are those of gastro-motor insufficiency, brought on 
by gastric and intestinal atony, by the mechanical disturbance caused 
by the descent of the organ, and neurasthenia. 

The patient comes to the physician complaining of pressure and 
fullness in the epigastric region, abdominal distention and flatulency, 
pain (gastralgia) coming on at irregular intervals, and independent of 
the digestive act or the quantity or quality of food. Eructation, 
nausea and vomiting are usually complained of. The patient is 
usually and often, profoundly neurasthenic. Nausea and vomiting in 
the more severe cases occur several times each day, little food is 
retained, the patient becomes more and more emaciated, neurasthenic, 
feeble, anaemic, bed-ridden, and a confirmed invalid. The picture, 
in a few words, is that of chronic severe atonic dyspepsia, with 
neurasthenia and increasing emaciation. 

The medical treatment consists in the administration of strychnia 
and other tonics. Regulation of the bowels. The selection of a 
suitable nourishing diet. Massage, electricity, cold water applica- 
tions and abdominal gymnastic exercises to strengthen the abdominal 
walls and increase the intra-abdominal pressure. The avoidance of 
tight lacing or wearing of any garment which restricts the waist. 
The wearing of clothing supported from the shoulders. The 
mechanic treatment consists in applying a properly selected, adapted 
and accurately fitting abdominal bandage to increase the intra- 
abdominal pressure. Where there is great weakness, the rest cure is 
a most efficient means of treatment. 

Alternating cold and hot intra-gastric douches are often efficient in 
restoring partial tonicity to the muscular walls. 

This medical and mechanical treatment when skillfully and per- 
sistently applied in a large percentage of the cases gives much relief 
and the patient is able to live on in more or less comfort. The 
application of the abdominal bandage, according to some authorities, 
may finally succeed in elevating the stomach one or two inches with 
more marked relief. However, the patient remains constantly under 
observation and is never restored to good health. These treatments 
arc those popularly and extensively employed throughout the world 



CURE OF GASTROPTOSIS. 2U 

to-day, and from the present standpoint the results are believed to be 
the best that can be attained. 

There is a considerable percentage of cases associated with severe 
symptoms in which the medical and mechanical treatments give little 
or no relief, the dyspeptic symptoms continue severe, the neurasthenia 



is profound and the emaciation and chronic invalidism continues. It 
is to these cases of gastroptosis that I wish particularly to call your 
attention to-day, and suggest a new, a surgical treatment. 
During the years 1897 and 1898, the late Dr. William Pepper and. 



212 MEDICAL SOCIETY OF NEW JERSEY. 

Dr. Alfred Stengel had under their care a patient suffering with the 
very severe symptoms of gastroptosis, in which every medical and 
mechanical treatment, including a prolonged rest cure, had been 
faithfully and skillfully applied with no distinct benefit. The patient 
was destined to chronic invalidism. 

At this time (March 1898) Dr. Pepper suggested to me that some 
operative procedure might be undertaken to restore the stomach to 
normal position in his patient. After a careful study of the anatom- 
ical relations and ligamentary supports of the stomach on the cad- 
aver, and considering the importance of preservation of the physiol- 
ogical mobility of a hollow viscera, I devised and practiced for the 
first time on April 5th, 1898, the following operation : The abdomen 
was opened midway between the zyphoid cartilage and umbilicus by 
an incision three inches in length. Three rows of interrupted silk 
sutures were placed from above downward and from right to left 
through the gastro-hepatic ligament or omentum and gastro-phrenic 
ligament. When secured, these sutures formed a broad transverse 
fold or plication in and shortened these ligamentary supports, 
elevating the stomach to normal position. 

A report of this first operation, with a description of the patient's 
illness and physical condition, was made before the Fellows of the 
College of Physicians of Philapelphia by Dr. Stengel and myself on 
April 19th, 1899. Since then we have operated upon two additional 
cases. One in October of last year, the other in May of this year. 

Since the description of our first case, Bier of Greifswald, Germany, 
1900, has reported four cases operated upon in a similar manner, 
except that fewer sutures were used, and in two of his cases the 
shortening of the gastro-hepatic omentum was supplemented by pass- 
ing two sutures through the serosa of the lesser curvature of the 
stomach and then through the capsule of the left lobe of the liver. 

Including these four cases operated upon by Bier, seven patients have, 
up to the present time, been treated in this way. All had suffered 
from five to ten years with the characteristic and very severe dyspep- 
tic and neurasthenic symptoms of gastroptosis. In two a right floating 
kidney had been operated upon without relief of symptoms. All werie 
emaciated, weighing between 78 and 115 pounds. In every 
instance the form of gastroptosis was the subvertical and pronounced. 
In four, the upper curvature of the stomach was at or below the 
umbilicus ; in one, two inches below the umbilicus ; in one, two inches 



CURE OF GASTROPTOSIS. 213 

above thb umbilicus, and in two, midway between the zyphoid cartil- 
age and umbilicus. 

In three an associated dilitation of the stomach was diagnosed, but 
was not demonstrable at operation. 

In none was there a diastasis of the recti muscles or any degree of 
relaxation of the abdominal walls, although four had borne children. 
Certainly in every case the severe symptoms of gastroptosis rendered 
the patients chronic invalids and incapacitated them for any occupa- 
tion or social duty. 

The convalescence in every instance was normal, the patient not 
suffering more than after any exploratory celiotomy. Our patients 
were kept in bed in the recumbent position for from four to six weeks 
after operation and on a special diet. 

Six of these patients have now been observed from sixty-five days 
to three years after operation. The one operated upon in May of 
this year is still in bed. In every case the improvement in health has 
been most remarkable, and the relief of symptoms complete. The 
dyspeptic and neurasthenic symptoms are entirely relieved ; they 
take without restriction any character of food. All have gained 
markedly in weight, and this gain had been lasting and increases 
with time, one, after three years, having gained forty pounds, 
and one, after one year and seven months, twenty-five pounds. 
Further, the gain in weight began immediately after the patients left 
the hospital, the least gain in two months being eleven pounds and 
the greatest nineteen and one-half pounds. In no instance, regard- 
less of the time which has elapsed since operation, has the stomach 
changed in position. In three, the line of lower curvature of the 
stomach is from one to two inches above the umbilicus, .and in the 
other three, from one to one and a half inches below the umbilicus. 

Duret, in 1897, Davis, in 1898 and Rovesing, in 1899, fixed the serosa 
or serosa and muscularis of more or less of the anterior wall of the 
stomach to the anterior abdominal wall, and Hartmann, in 1899. after 
plicating the pyloric end of the stomach fixed it with the plication 
sutures to the parietal peritoneum of the diaphragm beneath the left 
ribs. The firm fixation of the stomach to the abdominal wall and 
diaphragm and its distortion practiced by .these four operators must 
to a great extent destroy the physiological mobility of the stomach- 
and of necessity result in the production of the severe and painful 
stomach affections we frequently see associated with adhesions to 
this organ. 



214 MEDICAL SOCIETY OF NEW JERSEY. 

The operation we have devised, simply shortens the gastro-hepatic 
omentum, the natural ligamentary supports of the stomach, the normal 
mobility is preserved and it must .be considered ideal. With the 
formation of a broad surface of peritoneal adhesion between the sur- 
faces plicated, secured by the introduction of three rows of sutures, 
sufficient strength is gained in the shortened ligaments to perman- 
ently maintain the stomach in normal position. 

The immediate and lasting complete relief of symptoms, improve- 
ment in nutrition and gain in weight in the case of every patient 
thus far operated upon by this method of shortening the gastro-hep- 
atic omentum and gastro-phrenic ligament, would seem to prove that 
the dyspeptic symptoms were induced by the abnormal position of the 
stomach in gastroptosis, and that the neurasthenia is secondary to 
the dyspepsia. Also, the remarkable effect of the shortening of the 
li«;aments would appear to demonstrate that the cause of gastroptosis 
is a stretching out or lengthening of these ligaments. 

The completeness of relief, and to my mind, extraordinary restora- 
tion to excellent health of these six patients who had suffered for 
years with the severe symptoms of gastroptosis, strongly recommends 
this operation at least in every case of gastroptosis where the suffer- 
ing is marked. 

The medical and mechanical treatment at best secures only partial 
relief of symptoms, does not correct the cause, and entails constant 
treatment, diet and the wearing of cumbersome bandages, while the 
operation promises to at once completely restore the patient to 
excellent health. The danger of operation, with the best aseptic 
and antiseptic tt-chnique, can be little or no more than that of a 
simple exploratory celiotomy. I have estimated the mortality at one- 
fourth of one per cent. 

Though our experience with the operation is as yet limited, we feel 
justified in prophesying that the medical and mechanical treatments of 
gastroptosis, like that of floating kidney, and retroversion of the 
uterus, will, in the not far distant future, be greatly replaced by this 
surgical procedure we have devised and have just described. 

DISCUSSION. 

Dr. Emery Marvel, Atlantic City. — I think we should congratu- 
late Dr. Beyea upon the conception of this very promising operation. 
Certainly the report of the cases presented seems to justify the assur- 



CURE OF GASTROPTOSIS. 21 5 

ance of a good result. There are, however, two unfavorable possi- 
bilities which occur to me, in the details of the operation. One of 
these is the elongated gastro-hepatic mensetery, which, having been 
shortened by the adhesion of the folds, there is a possibility of its 
becoming elongated later. Gastroptosis is associated with dilatation 
of the stomach, and this organ being dilated there will certainly be 
atony of its walls, and this will finally lead to stagnation of its con- 
tents. This would predispose to gravitation and stretching upon the 
contracted ligament, thus favoring its secondary elongation. In gas- 
troptosis there is a pseudo-stenosis of the pylorus. This stenosis is 
brought about by the most dependable portion of the viscus being 
lower than the pylorus, necessitating the up-hill pushing out of its 
contefits. Owing to the overwork brought upon the muscular wall 
of the stomach, atony is usually the result. If the shortening of this 
ligament is permanent, it would certainly seem that Dr. Beyea had 
devised a means, and a simple means, by which this trouble may be 
corrected. Within the past few months I was in Leeds, and wit- 
nessed there an operation practiced by Mr. Mayo Robson, gastroen- 
terostomy. He uses the same operation, I think, to correct gastrop- 
tosis. His object is to drain the viscus from its dependable portion. 
He reports remarkable success. If Dr. Beyea has devised an oper- 
ation which will prevent subsequent stretching of the ligament, he has 
done even more, for he has retained the organ in its normal flex- 
ibility and mobility. 

Dr. M. Lampson, Jersey City. — I should like to ask the sexes of 
the patients operated upon by Dr. Beyea. 

Dr. Beyea. — Six were females and one was a male. 

Dr. Lampson. — Then it would seem that this condition of gastrop- 
tosis conforms to the condition found in prolapsed kidneys, and is 
largely seen in the female. So far as I know, the statistics of oper- 
ations on prolapsed kidneys in the female are not very satisfactory. 
The operation described would occur to one because of the similar 
operation done on the kidney. The long attempts to remedy medi- 
cally a condition seen in relaxed people, and the poor success thus 
achieved, would seem to justify, in such obstinate cases, a resort to 
this new operation, though, of course, the cases reported are too few 
to justify any very definite and positive conclusions. Like all other 
efforts to correct a relaxed condition, often dependent upon faulty 
dress and general habits, the results must be uncertain. 



2l6 MEDICAL SOCIETY OF NEW JERSEY. 

Dr. Philip Marvel, Atlantic City. — There are some questions 
from the medical standpoint, in contra^distinction to the surgical 
that seem to me to be exceedingly interesting, and about which Dr. 
Beyea may be able to give us valuable information. In the first place, 
in the majority of cases of gastroptosis there is greater or less dilata- 
tion. I was present at one autopsy in which gastroptosis was 
observed without any manifest dilatation, but certainly in the majority 
of cases there is dilatation. Since the operation does not cure the 
dilatation, the question arises : " To what extent does the operation 
assist in the cure of that chain of symptoms which are commonly 
observed by physicians in these cases ? Again, to what extent may 
we attribute the result obtained to the prolonged rest and the careful 
diet given these patients ? On the other hand, there are many cases 
of gastroptosis of which Dr. Beyea knows in which there are symp- 
toms of no more than slight indigestion. We should like to know 
the degree of dilatation accompanying gastroptosis which should exist 
in a case, to warrant resort to operation. In the case I am about to 
recite it is not fair to attribute all of the trouble to the operation for 
suspension of the stomach, but it is perhaps fair to state that these 
disturbances came on shortly after the stomach had been suspended. 
An operation was done for suspension of the organ, and this was 
shortly afterward followed by severe attacks of vomiting, which are 
uncontrollable to this day. A secondary operation was done — an 
enterostomy — the vomiting has continued, but the surgeon, and the 
physician in charge, believe that this vomiting is hysterical. The 
question nevertheless arises, to what extent are we to attribute this 
result to operation, and possibly to what extent to change of position 
brought about by the suspension of the stomach ? I think Dr. Beyea 
will bear me out in the statement, that there are many cases af gas- 
troptosis which do not require operation. It is for the surgeon to 
formulate the degree of gastroptosis, and the degree of dilatation 
requiring operation before we practitioners of medicine can have any 
definite idea as to which cases should be referred to the surgeon, 
and which cases should be treated medicinally and mechanically. 
From the surgical standpoint, I should say that where atony has 
taken place to such an extent as to greatly modify the digestive 
powers, suspension will perhaps assist in relieving the organ from the 
dammed up food which has been retained in it longer than it should 
have been because of the position of the same but it cannot cure. It 



CURE OF GASTROPTOSIS. 21 7 

may indirectly assist in relieving this condition, by allowing the 
stomach to empty itself sooner. This has been proven I think in 
some cases. In some very severe cases of gastroptosis that have not 
been operated upon the long-continued use of lavage in carefully 
cleansing the stomach, together with rest, has yielded quite as good 
results as the operation described in the paper. We are not prepared 
to say that it will be as permanent. I have now five cases of gastrop- 
tosis under my direction, some of them have required lavage before 
each meal, others not so frequent. Three are temporarily discharged 
and there is no evidence but what their digestive functions are fairly 
well performed. Two of the patients receive lavage at bedtime. I 
am impressed with the fact, that the use of the lavage in these cases, 
is to be recommended and especially at bedtime after the day's work 
is done, for the reason that the stomach being allowed to remain empty 
all night the secretion ferments are more nearly normal and the pro- 
gress is much better than when lavage is done at other times. 

Dr. R. C. Newton, Montclair. — I enjoyed this paper very much,, 
and the presentation of the subject is excellent. The last gentleman's 
remarks call to mind the fact, that the size, shape and position of the 
stomach vary considerably in health. I recall making an autopsy on 
a man who died after a very long spree. He had not taken food for 
about ten days, and his stomach was found no larger than the fist. 
If the stomach will contract so much from fasting for ten days, it 
follows that the stomach in health must vary greatly in size and 
position, and this should be borne in mind in connection with this- 
subject. 

Dr. Beyea. — It has been said by Dr. Marvel that the supports may 
again stretch. In reply, I can only say that over a year after the first 
patient was operated upon she was examined, and the stomach 
inflated. It was found that the stomach had not descended or changed 
in position in this period. I have here a recent letter stating that this 
patient has gained forty pounds, and is in excellent health at the present 
time. This operation has been compared to the operation for floating 
kidney. That operation is unsatisfactory only because the method 
has been imperfect, but this, I think, has now been done away with. 
The operation of fixing the kidney is often not followed by an 
improvement in the symptoms. Gastroptosis and prolapse of the 
kidney are often associated, and very frequently the anchorage of the 
kidney in such cases without attention to the stomach leads 



2l8 MEDICAL SOCIETY OF NEW JERSEY. 

therefore, to partial failure. It is now acknowledged that dilatation 
of the stomach in gastroptosis is not primary, but secondary, 
and is confined to the pyloric end of the stomach. It is the result of 
atony or relaxation of the stomach walls, and if the stomach 
be raised to its normal position the normal tonicity of the 
organ seems to return. Even assuming that the dilatation is primary, 
we can, if necessary, supplement the other operation by taking a reef 
in the stomach. Personally, I do not believe this is necessary. Of 
course, there are many cases of gastroptosis in which the patient is 
sufficiently relieved by medical means ; I only recommend the oper- 
ation at the present time when the symptoms are severe and the 
patient has not been relieved by a sufficient trial of medical treat- 
ment. I prophesy more for the operation in the future. As to the 
good effect being due to the rest and careful diet, I would say that 
the first patient operated upon by me had been treated in the hospital 
by Dr. Pepper for two years, and she had received the rest cure and 
all of the usually recognized methods of treatment without benefit. 
The operation, therefore, in her case was a last resort, and the patient 
eagerly accepted this chance for recovery. No evil results have fol- 
lowed this operation, though they have been known to follow when 
the stomach has been operated upon by other methods which 
restrict the mobility of the organ, as in the case referred to by Dr. 
Philip Marvel. The elevation of the stomach by shortening the 
natural ligaments is very different from fastening the stomach to 
the abdominal wall. Most physicians will agree that both the medical 
and the mechanical treatment of gastroptosis are far from satisfactory, 
and must be kept up indefinitely. 



Report of a Case of Intestinal Obstruction. 

BY E. A. Y. SCHELLENGER. M.D., CAMDEN, N. J. 

The family history is entirely negative. The only important feature 
of the previous history was a vague suspicion of hernia, yet the 
physical examination did not support it. 

The patient was a male adult, fifty-nine years of age, a farmer by 
occupation. The present condition apparently was preceded by a 
period of two years, during which there occurred several attacks of 
<:olicky painjsituated throughout the abdominal region, these paroxysms 



CASE OF INTESTINAL OBSTRUCTION. 219 

of pain were accompanied by nausea, vonniting and lassitude — in fact 
just those symptoms which would ordinarily be present in an attack 
of acute gastro enteritis. 

The last attack occurred on the 25th of April, 1902, at which time 
the patient was suddenly seized, while at work, with severe pain in 
the abdomen, centered in the umbilical region ; this attack was of 
such intense severity that the sufferer was compelled to assume a 
recumbent posture, which position, after some length of time, greatly 
lessened the acuteness of the pain so that he was able to resume his 
accustomed work. 

This relief was suddenly terminated by another attack more severe 
than the former one, causing the patient to go to bed. After the night's 
rest (which included sleep of some hours) the patient was free from 
pain and encouraged by this relief, arose. While dressing, the pain 
returned ; he again went to bed and remained for twenty-four hours, 
after this period of rest there being no discomfort, he again arose and 
having a desire for food, he ate a larger breakfast than usual. After 
this repast he started for work which was a considerable distance 
from the house. While working he was suddenly seized with excru- 
ciating pain, the agony was so great that he threw himself upon the 
ground, from Which place he was carried and placed in bed. A 
physician was called at this time, who, finding that there had been no 
action of the bowels for several days, ordered an enema, which 
brought away a small quantity of fecal matter; this not giving a suffi- 
cient result, rochelle salts was administered hourly. After a lapse of 
some hours the pain increased in intensity and vomiting reddish brown 
in color — having the apparent consistency of blood, occurred ; this 
condition became so alarming that the attending physician referred 
the case to me and I at once hastened the case to the hospital ward. 

Upon examination of the patient at the time of admission, five days 
after the onset of the first symptom, I found him in a state of collapse 
— pulse 120, respiration 34 and shallow, temperature 97.4^, skin moist 
and clammy, his face had a distressed appearance, his position was 
dorsal with legs flexed. 

Upon inspection of abdomen, it was found to be slightly distended. 
Palpation showed that the abdominal muscles were very rigid and no 
enlargement noticed at either inguinal region. 

Upon percussion the abdomen was tympanitic — rectal examination 
gave negative results. 



220 MEDICAL SOCIETY OF NEW JERSEY. 

The patient consenting to a laparotomy, the abdomen was prepared 
according to the usual custom, the anaesthetic (ether) was administered 
and, led by the fact that there was a suspicion of hernia, I made the 
incision in the right inguinal region. After thorough exploration no 
hernia was found ; enlarging the incision upwards to the extent of two 
inches, upon intro-abdominal examination, the csecum was collapsed, 
thus knowing that the seat of obstruction must be in the small intes- 
tine. After a careful search through this wound I was unsuccessful 
in finding the point of disturbance, and was forced to eviscerate, 
covering the bowel with warm, moist gauze sponges (saline solution) 
as they escaped. 

In examining the bowels separately I came upon a portion of the 
small intestine which was very much distended, and following this 
carefully, discovered a point of adhesion between two portions of 
bowel which proved to be a volvulus— reposition was effected by 
breaking up the adhesions, leaving a denuded surface on each fold of 
the bowel which was carefully cleansed and closed by Lambert's 
sutures of silk. The abdominal cavity was flushed with hot saline 
solution — the abdominal wound was closed without drainage. 

The patient recovered from the immediate effects of the operation 
and passed through an uneventful convalescence covering a period of 
twenty-five days. 



Report of a Case of Tumor of the Orbit. 

BY GEORGE EVANS READING, M.D., WOODBURY, N. J. 

On June 20th, 1901, I was called to see MissB. V. F., aged 23 years* 
The following history was elicited : On the morning of February 
26th, 1 901, she first noticed a swelling of the left eye, which subsided 
during the day. This occurred daily for several days, when the swel- 
ling became permanent. Soon the right eye became affected in a 
similar way and gradually became more prominent, the left eye 
remaining stationary. During this time she was under treatment by 
two local homeopaths; but, receiving no benefit from their treatment^ 
she went to Wills Eye Hospital, Philadelphia, where she was told 
that the eye would have to be removed. 



A CASE OF TUMOR OF THE ORBIT. 221 

Up to this time, the latter part of May, ; her general health had 
remained fairly good, and she was able to continue her occupation, 
that of a domestic. 

On June 5th, she had an attack of vertigo which left her very weak. 
After this attack she noticed a swelling under the right arm which, 
however, disappeared in about two weeks. 

I found the patient in bed, complaining of great weakness and much 
headache of a neuralgic character, beginning in the right eye and 
radiating over the head. The temperature was 103.5, pulse 120, very 
quick and weak in character. There was marked anaemia. 

The left eye was normal in position ; but the lids were edematous 
and of a dark purple color, the right eye was pushed forward nearly 
an inch from its normal position, the lids being very much swollen and 
of a dark purple color. The conjunctiva was highly inflamed, par- 
ticularly the palpebral surface. On palpation, a morbid growth could 
be felt projecting well out toward the edge of the orbit, both above 
and below the eyeball. The tumor seemed of about the consistence 
of suet and had a smooth surface. 

The patient was put upon digitalis and strychnine for the heart and 
upon the so-called *' migraine tablets," for the headache and fever. 

By the end of a week she was free from fever, but very weak and 
anaemic. She was then placed upon a tablet containing the phosphates 
of quinine, iron and strychnine, for the anaemic condition. 

Locally, I used the boric acid lotion with one grain of zinc chloride 
to the ounce ; but it did the eye no good. I then concluded to try the 
solution of adrenalin chloride, hoping that by its action in constricting 
the blood vessels, it would relieve the congestion of the lids and con- 
junctiva which seemed to be the cause of the pain. In this we were 
successful, the injection of the lids and conjunctiva becoming very 
much less marked and the pain being correspondingly lessened. The 
patient's general health gradually improved and in a few weeks I 
noticed that the eye was less prominent. Ascribing this to a shrink- 
age of the tumor due to the action of the adrenalin, I concluded to 
push the drug and began the administration of fifteen minims of the 
solution three times a day, by the mouth, in addition to its use locally. 
The effect was really marvellous, the tumor diminishing rapidly in size 
and the eye receding until, in about six months, all traces of the 
tumor had disappeared and the eye had resumed its normal position. 
I have seen this patient recently, and the only thing left to remind her 



222 MEDICAL SOCIETY OF NEW JERSEY. 

of her condition one year ago is a slight wrinkling of the lids of the 
right eye, due, no doubt, to the great stretching of the skin. 

I greatly regret that I cannot present photographs of this patient ; 
but she would not submit to having them taken. 

This case is presented for the purpose of encouraging the trial of 
adrenalin in similar tumors. It may even be possible that in the animal 
extracts will be found remedies for other morbid growths. 



The Power of Vaccination in Preventing 

Smallpox. 

BY J. F. LEAVI IT, M.D.. UKALTH OFFICER, CAMDEN, N. J. 

Mr. President and Gentlemen : 

In beginning this paper it will be necessary to give a brief history 
of variola in order to show just what vaccination has done in stamp- 
ing out one of the most loathsome, dreaded and deadliest diseases ever 
known to mankind. In the words of that English historian, 
•' Macauley," who said, in describing its awful ravages in the seven- 
teenth century, " Smallpox was always present, filling the church 
yards with corpses and leaving on those whose lives it spared the 
hideous traces of its power marked upon their faces." 

According to history variola dates back to a remote period before 
the Christian era. There is no definite knowledge concerning the origin 
of this disease. It is said by some historians and writers that it first made 
its appearance in Egypt about A. D. 544. It is also said by some 
writers on the subject that Philo, a Jewish philosopher, mentioned it 
in a work on the life of Moses, which was written in the first century. 
It is known to have spread into Asia and Africa about the sixth or 
seventh centuries. It was carried by the Spaniards into Cuba and 
San Domingo soon after the discovery of America and raged in 
Mexico in 1527, and its victims were numbered by the millions. From 
there it gradually extended over the whole American continent. 

History tells us that the first accurate and scientific description of 
variola came from a celebrated Arabrian physician by the name of 
*• Rhazes," A. D. 925-26. From the earliest ages its awful visitations 
seemed to have been common throughout the world, accompanied by 
great destruction to human life. 

At one time smallpox destroyed the lives of about 3,000 to each 
1,000,000 of inhabitants, each year in England. In France, about 



VACCINATION — SMALLPOX. 223 

30,000 perished each year. In the Russian Empire, reports say that 
smallpox was so malignant that 2,ooo,oco perished in a single year. 
Smallpox is ho respecter of person or climate. Many of the lives 
of crowned heads of kingdoms and empires were destroyed by this 
disease during the sixteenth and seventeenth centuries. 

During the sixteenth century, in Mexico, 3,500,000 perished from 
smallpox. In 1734, nearly two-thirds of the population of Greenland 
were swept away by an epidemic. In Iceland, 18,000 persons died out 
of a population of 50,000. Among the savage nations the ravages have 
been no less disastrous than the civilized, whole tribes have been 
exterminated by this disease. 

Writers have also graphically described the horrors it wrought 
among our North American Indians. 

Smallpox never entirely ceased, and every four or five years it 
became a great epidemic. During the years when there were no 
epidemic the death-rate from this disease was about one-tenth of all 
mortality, in the epidemic years, one-half. 

Very few men escaped smallpox ; almost every one sickened at 
least once in his life. One-third of all the new-born children died of 
smallpox before their first year, and one-half before the fifth, and 
thousands were maimed by loss of sight. So horrible were the 
ravages wrought by this disease that as a means of preventing or 
modifying it inoculation with smallpox virus was introduced and 
became a practice among the people of different countries. This 
practice dates back to a very early period in the history of smallpox. 
In the year 1722, this practice was adopted in England and America. 
This practice mitigated the loss of life and contagious effect to some 
degree by resulting in a comparatively mild form of the disease. 

It proved to be a benefit to those inoculated, but a constant source 
of contagion was established. On this account the general mortality 
was greater than before the practice was known, for this reason, 
England, by an act of Parliament, passed in 1840, rendered inocula- 
tion of this kind unlawful. 

In 1798, Edward Jenner, M.D., an English surgeon, who had been 
making investigations and experiments on the subject for a number 
of years made known to the world his discoveries and proved the 
correctness of his theory by experiments, for in two years Jenner 
inoculated over 6,oco subjects with the viius of cow pox, and those 
persons were afterward exposed to smallpox without effect, but, like 



224 MEDICAL SOCIETY OF NEW JERSEY. 

all new discoveries, it met with more or less disapproval from the first. 

The news of Jenner's discovery and experiments was soon brought 
to this country. The Boston Board of Health with a corps of 
eminent physicians were among the first in this country to experi- 
ment with the Jenner discovery and proved, beyond any doubt, that 
vaccination would prevent the disease. It is true, that from time to 
time we still have epidemics of smallpox ; this, I believe, is because 
-vaccination and revaccination has been neglected from some cause or 
another. Many will not get vaccinated because they say they do 
not believe in it, and yet they know nothing about the history of 
smallpox or vaccination. It has been a long time since this section 
of the country has had an epidemic of smallpox until within the last 
eighteen months. In nearly every section of the United States there 
have been epidemics, and have caused great loss of life. This, I 
believe, could have been averted, had the people all been successfully 
vaccinated. Thousands of children have been left to grow up without 
being vaccinated, while others should have been revaccinated. 

With the pure virus produced now by chemists and put in our 
hands, there can be no danger in vaccination, if properly done and 
cared for afterward, and, if successfully done, the immunity it affords 
to a person is as sure as the immunity from smallpox itself. I am 
more thoroughly convinced of this fact from my own personal experi- 
ence and observations in the last j'ear, than I ever was. 

Being Health Officer of the City of Camden for several years, and 
also physician to and in charge of the Municipal Hospital there, I have 
seen all the cases of smallpox that occurred in the city. 

The past year we have had over 200 cases, of this number only 38 
had ever been vaccinated and none later than ten years. At the 
hospital since November 9th, this year, we treated 130 cases, out of 
this number only 28 had ever been vaccinated and most of these in 
early life, none later than ten years, most of them over thirty years. 
Of those who died none had ever been vaccinated. Those who had 
once been vaccinated had very mild attacks, excepting two who had 
smallpox in a semi-confluent type, these were vaccinated twenty-five 
and thirty years ago respectively. To counterbalance this, we had 
one case of confluent smallpox in a person who had had confluent 
smallpox thirty years ago. This statement was verified by the pits 
on the face and body and by his friends who knew him at that time. 
•Out of the 28 cases that had been vaccinated, 12 had only been vacci* 



VACCINATION — SMALLPOX. 225 

nated within one week before coming to the hospital and of these the 
majority, after the first symptoms had appeared. Where vaccination 
had been done a few days previous to the first symptom the disease 
was very much modified. Being health physician, it was my duty to 
call on all as soon as reported to me. 

On seeing the patient I made it my duty to first find out if he or she 
had ever been vaccinated, and satisfying myself that it was smallpox, 
I would then turn my attention to the others in the house and 
endeavor to vaccinate all who had not been recently. In most cases 
I would be allowed to vaccinate all, some would put me off by insist- 
ing that they would rather have it done by their own physician, but 
did not. Wherever I had a case of smallpox, if it was early or the 
eruption had not appeared more than a day or two, I satisfied myself 
that all were vaccinated who had been in the house or had been 
exposed. In not one instance did I have another case in that house. 

In many instances where smallpox would appear in a house, some 
would consent to be vaccinated, while others would not ; none who 
were vaccinated contracted the disease, while those who were not 
vaccinated did. This did not happen only once, but many times. In 
one case where a child ten years of age going to school had been 
vaccinated, her two smaller sisters were not, their mother got smallpox, 
the ten-year old one was taking care of her, later the two younger 
ones contracted the disease, the older then had them all to take care 
of, she never took the disease and was with them constantly. 

In another case, a small child, whom I vaccinated and took to the 
hospital with its mother who had the disease, and was compelled to 
stay there five weeks, never took the disease or showed a symptom. 
There were several instances where children with the disease and the 
mothers were allowed to go to the hospital with them after vaccinating 
her, in no instance did they contract the disease or have a symptom. 

We had many nurses, none of whom ever had smallpox, but 
depended on vaccination for protection. The resident physician, as 
well as all our helpers in and around the hospital, escaped the disease 
through the powers of vaccination. 

During the epidemic we were compelled to enlarge the hospital, we 
issued orders that no workman would be allowed on the grounds until 
successfully vaccinated, however one carpenter and one painter suc- 
ceeded in getting work without having it done or complying with our 
- orders ; both contracted the disease and one died, none of the others 
showed any symptoms. 

15 



226 MEDICAL SOCIETY OF NEW JERSEY. 

During the month of May, last, I was called to a case of an old 
lady about the fourth day of the eruption. In the house with the old 
lady were two men, two women and a baby ten months old. One of 
the women had been sleeping with the old lady, the others had all 
been with her, the baby had been kissed and fondled by her all this 
time until I pronounced her case smallpox. I vaccinated the baby 
and both women, all took well. One man had recently been done, 
the other had not, and would not. All escaped the disease but the 
man who refused to be vaccinated, he claimed he was not afraid of 
taking the disease because a physician had given him powders that 
would protect him ; he had a confluent case. 

I, myself, have never had the disease, I have been with it almost 
constantly for the last year, and visited the hospital every day for the 
last six months. All I depended on was vaccination. I could go on 
and mention many more instances as positive proofs that vaccination 
will immunize from smallpox, but I think this will suffice to convince 
the most skeptical unbeliever. 

In conclusion, my experience with the powers of vaccination is 
That it diminishes the liability of an attack of the disease. That it 
modifies the character of the disease, causing a much less fatal and 
less severe type and that it absolutely protects from the disease, if 
done recently. That in the majority of cases the efficacy of vac- 
cination never entirely ceases. That revaccination restores that pro- 
tection which time has diminished. That the beneficial effects of 
vaccination are in proportion to the thoroughness with which it is 
performed. 

In summing up, vaccination, is to my mind, one of the greatest, if 
not the greatest of the scientific discoveries in the history of medicine. 



Report of the Standing Committee. 

Mr, President and Gentlemen : 

In May your Chairman addressed personal letters to the reporters 
of the District Societies urging them to perform the duties of position 
as laid down in the By-Laws, Chap. 2d, Sec. 7th, leaving the details 
of the method of obtaining the information they might desire to their 
individual judgment, and hence, no circular letters were issued as in 
former years. Reporters from Bergen, Burlington, Camden, Glou- 



REPORT OF THE STANDING COMMITTEE. 22/ 

cesler, Essex, Hudson, Hunterdon, Mercer, Middlesex, Somerset and 
Warren have replied and, therefore, are entitled to sit as delegates at 
this meeting. 

From the reports thus gathered it is noticed that the enthusiasm in 
County Societies still continues, an enthusiasm which seems to have 
been aroused markedly within the past two or three years, and is due 
I think I may safely state, to an honest rivalry among the District 
Societies of the different sections of the State. No small factor stimu- 
lating this emulation is the interchange of delegates with adjoining 
County Societies — a custom which seems to be on the increase. And 
so it should ; it promotes good fellowship, fraternal courtesies and 
affords opportunity for the giving and receiving professional experi- 
ences. Nor is this lessened by the universal custom of including 
among the invited guests the specialists of note, whose practical 
addresses lead the general practitioner into his line of thought. Then, 
too, we notice that while mention is made of the ''working sessions," 
so to speak, no little stress is laid on the annual meeting, with its 
accompanying banquet, its short business, but still longer social 
session, spent in friendly and social conversation on topics not strictly 
medical. These *'annuals" are becoming more and more observed, 
and rightly ; they help a great deal to lighten the cares, anxieties and 
perplexities of the busy practitioner, they go a great way toward heal- 
ing the wounds caused by the sharp knife of competitive, though 
honorable, strife for professional success. Let the annual banquets 
be a part of the societies routine. 

The increase in the membership of the societies has been marked 
Somerset reports three new members ; Mercer, five ; Middlesex, seven 
and Hudson, twenty-one. The reporter of the last enthusiastically 
remarks that, "while we may be second in point of numbers to any 
County Society, we stand second to none in instructive and interesting 
meetings." No doubt other counties, if reported, would show as large 
or larger gains. 

As to the health of the State, with the exception of variola, it has been 
fairly good. One feature of the reports is the almost entire failure to 
mention the malady which has been our perennial visitor since '90, 
epidemic influenza. Scarce one cites it as prevailing, and if cited, 
notes that it has almost disappeared. Perhaps it has been in accord 
with David Harum's logic : a good thing to have something else to- 
think about. 



228 MEDICAL SOCIETY OF NEW JERSEY. 

The epidemic which has attracted the most attention, and that it 
has been a true epidemic goes without the saying, is variola. Two 
hundred cases in Camden, one hundred and five being treated in the 
Municipal Hospital, twenty-five cases in the Municipal Hospital in 
Trenton, twelve cases in New Brunswick, one hundred and twenty-five 
cases in Hackettstown, many cases in Newark, and many cases still 
existing, are only a few of the portions of our state affected by the 
scourge. The number of cases reported and the number of deaths, 
are too meagre and indefinite to make any attempt at the percentage 
of mortality. This can only be done when the full reports are syste- 
matically tabulated, but each reporter speaks unqualifiedly of the 
positive evidences of the protective and ameliorating power of vaccina- 
tion. Dr. Leavitt, of the Municipal Hospital in Camden, avers that : 
"Genuiue vaccination diminishes the liability to, modifies the character 
of, and if recently done, absolutely protects from variola." Protec- 
tion never ceases entirely, but re-vaccination restores protection. It 
is a fact, not satisfactorily explained as yet, that many cases of tetanus 
followed vaccinations, and that the introduction of the virus gave rise 
to a much greater degree of inflammation and systemic involvement 
than we have been accustomed to observe, even when performed in 
former years under less aseptic precautions than in vogue at the 
present day. It may be that some of the papers to be read at this 
session may throw some light on it. Dr. T. B. Rogers, of Gloucester 
County Society, presents a very instructive paper on Vaccine-Tetanus. 

The subject of tuberculosis has been quite frequently before the 
societies, as evidenced by the papers read at their sessions. This has 
been in line with the efforts of this Society towards the establishment 
of the sanatorium. And here it may be stated that the societies, 
with a will, took up that subject as evidence by the frequent appear- 
ance of articles in the newspapers intended for the education of the 
laity. Hudson mentions the paper on tuberculosis — medical and 
surgical— by Dr. Lambert, and Dr. Long, of Somerset, furnishes a 
paper on tuberculosis of the spine. In fact, by the effort of this 
Medical Society to establish a sanatorium for the tuberculous, the 
whole State has been stirred up to see the importance of the work 
and the good which can be accomplished. 

Of typhoid fever, but little mention is made. Twenty-seven cases 
are reported by Dr. Leavitt, in the Camden hospital. Whether the 
Delaware river still furnishes Camden with a part of its water supply 



REPORT OF THE STANDING COMMITTEE. 229 

is not stated, but Bordentown drinks from that pure and limpid 
stream, which Dr. Sliipps thinks will account for the large number 
of cases in his practice. 

One hundred and twenty-eight cases of diphtheria are reported as 
occurring in Camden, while Drs. Hawkes and McGallaird, of Trenton, 
give their experience in the treatment of it with and without antitoxin. 
The mortality is 28.6 without, and 11.3 with. 

Hospitals. — The hospital established at Somerville last year is 
reported as being well under way, generally all the beds occupied, 
and a number of major operations performed, with successful results. 
The staff give monthly service and the hospital is in charge of a 
graduate nurse, of the Pennsylvania hospital, Philadelphia. 

A new hospital building was opened at Morris Plains Asylum, 
November 20th, 1901, at which the public were welcomed by an 
address by Dr. Evans, superintendent. 

The hospital at Bridgeton continues to do good work. The third 
anniversary was celebrated on the nineteenth of this month, and the 
first class of trained nurses, four in number, were graduated. No 
dispensaries are connected with the hospitals in Somerville and 
Bridgeton. 

The Medical Library Association, of Trenton, is growing in size 
and already some five hundred volumes are upon its shelves for the 
use of its members. 

A new and modern hospital for contagious diseases has replaced 
the old and antiquated building used for that purpose, for many years 
in Newark. 

Those who will peruse the Transactions when published, will find 
several interesting cases and papers quoted in the reports. 

No requests were made for opinions on the subject under discus- 
sion at this meeting, '* What are the best methods to prevent the 
spread of tuberculosis." for the reason that heretofore, most of the 
discussion of the topic before the Society has been given by the 
Chairman of the Standing Committee in his report, when he has 
quoted the opinions furnished by the reporters, in full. In order to 
remedy this, no opinions were asked, and it may be that from the lack 
of any previous expressions, more discussion may be elicited. 

The following papers have been received : 

An unusual case, by Dr. C. R. P. Fisher. 

Gonorrhoea, by Dr. Simmonds. 
. Vaccine-tetanus, by Dr. Rogers. 



230 MEDICAL SOCIETY OF NEW JERSEY. 

Death has dealt lightly with our numbers during the past year, but 
we record with deep regret the following missing ones from our 
circle : 

Camden — Paul M. Macray, June 26th, 1902. 

Cumberland— W. H. C. Smith, Millville, February 12th, 1902. 

Essex — George Bayles, Orange, December loth, 1901. 

Thomas Dunn English, Newark, April 20th, 1902. 
Hunterdon — Henry Race, Pittstown, April 20th, 1901. 

Mathias Abel. 
Middlesex — Henry R. Baldwin, New Brunswick, February 4th. 1902. 
Morris— George M. Swaim, Chatham, April 26th, 1901. 
Somerset— H. G. Wagoner, Somerville, July ist, 1901. 
Obituaries of many of these have been furnished and with others 
will appear in the Transactions. 

Respectfully submitted, 

H. W. Elmkr, Chairman. 



Progress in State Medicine and Hygiene. 

BY EDWARD E. WORL, M.D., NEWARK, X. J. 

When we recall how recent is most of our sanitary legislation, the 
interest shown in its progress is most gratifying ; a general unanimity 
of opinion. on the part of the profession would further advance this 
progress and secure desirable legislation. 

First. — We call attention to the anti-pollution commission of five 
members, particularly for the Passaic Valley (here is relief for one-half 
million of people) if we were to criticise, we would say its powers were 
not extended enough, and to a certain extent they must travel over 
ground which has been gone over, and again gather facts which have 
been substantially ascertained. We have a coast line of about 120 
miles ; our State averages forty to fifty miles broad, with the sea at our 
doors, a system can be arranged to carry off all our sewage and 
restore the rivers of New Jersey to their pristine purity, and this can 
be so managed as not to become a nuisance to our fast growing sea- 
coast towns. 

Second. — The last few years has shown a great change in the attitude 
of the profession towards consumption and the public grasp eagerly at 
any solution of the problem. The passage jof a bill granting $50,000 for 



STATE MEDICINE AND HYGIENE. 23 1 

a State home is a step in the right direction. The time is ripe for each 
community to establish sanitoria and to find in the early restora- 
tion to health of its citizens, a paying investment. We call attention 
to a new method now on trial by the Newark Board of Health, which 
carries great possibilities. 

A proportion of tubercular cases die from the direct effects of the 
germ. Here the disease assumes the form of acute general or 
miliary tuberculosis — rapidly fatal — but the chronic cases run months 
and years and tend to recover, but with less resisting power, become 
infected with other germs — pyogenic cocci and lodging in the tissues 
already devitalized, cause destructive changes, forming cavities and 
destroying adjacent tissues. The toxic products absorbed into the 
system, play a prominent part in the production of '• fever," '* night- 
sweats " and "loss of appetite," and the general condition of '* sepsis." 
With such a variety of germs, it is hardly likely that any two persons 
have exactly the same tubercle germ, and same *' associated bacteria " 
or combinations of these. Toxins are prepared for immunizing horses ; 
these are taken from selected portions of the patients expectoration 
and added to beef tea and placed in the incubator for five days. 
These cultures giving an offensive odor, were sterilized with ^^ of i ^ 
carbolic acid and filtered through porcelain. These had feeble toxic 
power. 

Small doses were at first injected in the selected horse, and these 
gradually increased. Each week a fresh sputum from the patient 
was prepared and injected, until horses took doses 180 cc. without 
disturbance. During this time *' tuberculin " was also injected in 
gradually increasing doses. When the horses were able to stand 
large doses of the combined toxic products, some blood was drawn, the 
serum tested on a series of guinea pigs to prove that it contained 
no deleterious material. After proving it harmless the injection of 
the patients was begun. 10 cc. was injected into the patient for whom 
the horse-serum was prepared, with gratifying results. Thus far 
the drawbacks noticed are chiefly anti-toxin urticaria and joint pains. 
These are balanced by the general improved condition. 

Naturally you ask the results ; these extend over a period of six 
months and upwards of sixty patients, all but three show physical 
improvement ; appetite and weight improved. A man 64 years, 
showed increased weight, and this is rare, much rarer than in young 
patients. The method is yet in the experimental stage, and we must 



232 MEDICAL SOCIETY OF NEW JERSEY. 

distinctly classify our cases. It is not so much the acute miliary 
tuberculosis as those of more chronic order — the method reverses the 
usual order. We strive first to overcome the ** mixed toxins " pro- 
ducing *' sepsis," for these in most phthisis cases have more influence, 
then we immunize against the " tuberculosis infection," per se. The 
horse blood is first rendered anti-toxic against *' septic germs " and 
then the tuberculin in the horse is increased, and the serum is then anti- 
toxic against " tubercular infection." Perhaps, no two cases are 
exactly parallel in its " mixed toxins." We have conquered diphtheria, 
we are on the edge of a greater victory over the great destroyer of 
human life. 

We are again face to face with an old enemy, periodically 
appearing, and we have to learn again the old lesson of ** smallpox 
and vaccination," for our new Spanish colonies are not unmixed 
blessings. The Spaniard neglects hygiene ; he sucks the juice of the 
orange, the rest takes care of itself. From these colonies, our troops 
returning homeward, brought back a peculiar type of " smallpox " a 
type leading to many errors of diagnosis and consequent spread of 
disease. 

It differed : 

(i). In the mild type of the disease. 

(2). In the absence of secondary fever and complications. 

(3). The low death-rate. 

(4). It favored the black race. 

But it spread rapidly, and to-day the question is a very different 
one ; the old disease is with us in all its original power. In the pro- 
portion that we neglect our vaccinations, in that proportion we suffer. 

Some of the old vaccinations had a thoroughness which does not 
seem to be present to-day — are we exhausting our virus ? Is there 
too much refining.? Beginning January i, 1902, I have examined the 
vaccination marks of 209 cases of smallpox, taking the history of the 
patient, his body marks, and comparing the progress of the disease 
Of the 209 patients, 99 had never been vaccinated. 

(i). The ages were as follows: — Under 5 years, 31 ; 5 to 20 years, 
16; 20 to 60 years, 52. Total, 99. 

(2). There had been vaccinated in childhood, 61. The ages were 
as follows:— 5 to 20 years, 5 ; 20 to 60 years, 52; over 60 years, 4 
Total. 61. 

(3). Forty-eight were vaccinated after smallpox was discovered at 



STATE MEDICINE AND HYGIENE. 233 

their homes hence they had modified smallpox. Ages as follows: — 
Under 5 years, 11; 5 to 20 years, 12 ; 20 to 60 years, 25. Total, 48. 

(4). A second attack of smallpox occurred in a patient, aged 52 
years, whose first attack was at the age of 3 years. 

P'aial Cases. — Of the 209 cases 36 died, and of these 27 had 
never been vaccinated ; six had been vaccinated in childhood and two 
were vaccinated when there was smallpox in the house. Of the 36, 
26 were white and 10 colored. 

' Conclusions. — First. — The disease prevails among the unvacci- 
nated. There are two classes: (i). Those who never have been 
vaccinated. (2). Those vaccinated in childhood and whose immunity 
has expired. Here we have 160 cases and 33 deaths. 

Second. — Of modified smallpox, we find 48 cases and 2 deaths, 
these due to complications. Most of these were not vaccinated until 
exposed to smallpox. 

Third.— Observation shows that immunity conferred by vaccination 
is exceedingly valuable : it varies with the individual — we cannot tell 
the exact years of safety. 

Fourth. — Smallpox does not always protect against itself ; <'.^., a 
man at 52, whose first attack was at 3 years. 

Fifth. — The value of vaccination is in proportion to its efficiency ; 
the same rule may be applied to smallpox, for we have been able to 
vaccinate a number whose faces showed pitting and claimed to have 
had the disease. 

Sixth. — The fact that we are unable to vaccinate a patient, even 
after several trials, does not necessarily insure that patient from an 
attack of smallpox. We are immune in proportion to the efficiency of 
our vaccination. 

Vaccination is a question underlying the interests and pocketbook 
of every community. Optional vaccination has not protected the 
community from smallpox. A century of experience is a warrant for 
us to advocate compulsory vaccination, but a measure of this kind 
was defeated in the last Jersey Legislature. The good citizen gets 
vaccinated and pays his taxes ; the man who is unvaccinated often is 
a wanderer, with no interest in the community, but he gets the benefit 
of the taxes. Has our idea of personal liberty gone to such extent 
that we cannot accept the plain teaching of experience ? The unvac- 
cinated are a real danger in our cities and deserve to be classed with 
the enemies of society. We are lacking in our duty as physicans 



234 MEDICAL SOCIETY OF NEW JERSEY. 

unless we advocate the lesson of our experience, for the physician is a 
teacher. So that it may become a law — the school law requires every 
scholar to be vaccinated, and is to-day the only compulsory law. If 
this is rational, it ought to be extended to all, for I hold this true, that 
no man ought to be able to give a loathsome, contagious disease to 
another. It violates the golden rule, and the antivaccinationists ought 
to be placed in colonies by themselves, so they can have the full benefit 
of their smallpox ideas, and pay their own expenses while going 
through the disease. 

From time immemorial the Jersey mosquito has been celebrated, 
but it remained for modern science to show its possibilities as carriers 
and propagators of disease. The success of the experiments on the 
Roman Campagna and the success of the U. S. authorities in clearing 
Santiago and Havana of yellow fever, show what can be achieved in a 
new field. Our last Legislature has granted $10,000 to advance our 
knowledge of the mosquito, while only a few species may be carriers 
of disease, yet it is desirable to control the spread and breeding of an 
annoyance. It can be met by drainage and tilling of waste and stag- 
nant places. New Jersey is not by any means the only home of the 
mosquito. We have long carried the odium of a pest which we should 
share with other states. 

Results of Medical Inspection Schools.— One of the great 
advances made of late years has been the introduction of a system of 
medical inspection of public schools, a system now in use in Asbury 
Park, Paterson and Newark. Much was expected of the system in 
the matter of public health. I have examined the records of Newark 
for six months — October i, 1901, to April i, 1902. The results are 
as follows : 

Number Examined. — Males, - 3,535 

Females, - 3,878 

Total examined, - 7,413 
Excluded for cause, 2,028—27 per cent, of the examined. 
Chief causes: — 

(i). Vermin, - - - 1,018 — 50 per cent, of the excluded. 
(2). Contagious eye diseases, 325 — 16 
(3). Skin diseases, 
(4). Ringworm, 

Total. - 
Measles and Scarlet Fever, 



152- 


■ 7i 


60 


1 


1.555 


11 


39- 


- 2 



PROGRESS OF DISEASES OF THE NOSE. 235 

The number of those examined and excluded for cause is suffi- 
ciently great to warrant some opinion as to the results. A glance at 
the figures shows us that the gain is mostly in the direction of personal 
cleanliness, and the cure of some minor diseases. An argument 
brought forward was that we would find this a great aid in the early 
detection of contagious diseases of childhood. This promise does 
not seem to have been carried out, for of measles and scarlet fever we 
find but 39 cases, or 2 per cent. Our system is still deficient, for it 
should include eye examination to detect ordinary errors of refraction. 
Many a pupil might be considered as deficient when the cause justly 
would be simple inability to see properly. 



Progress of Diseases of the Nose. 

BY B. A. WADDINGTON, M.D., SALEM, N. J. 

Careful inquiry, beside personal experience, it is sad to say, shows 
little advance in nasal medication and surgery, the old routine treat- 
ment being the rule. 

The numerous preparations on the market are mostly but fads of 
the profession, pushed by the manufacturer. 

The only definite changes are the great improvement in the treat- 
ment of atrophic rhinitis and the value of supra-renal gland in 
hemorrhage. 

In atrophic rhinitis we can feel encouraged with the prognosis. 
There is no class of cases that appreciate the misfortune so much and 
none so grateful for the relief. If it were the writing of a compend, 
one could use technical terms and by that means fill space. 

Atrophic Rhinitis.— The origin of the atrophic form of rhinitis 
is without question of remote specific diathesis. The family history 
when carefully looked into gives frequent examples of this state, vary- 
ing in its gravity as to the case. Other lesions can at times be dis- 
covered that settle the cause, as for instance: Hutchinson's teeth; 
occupation is also a factor. That class of labor that brings the person 
into contact of fine dust of any kind. The inhalation setting up an 
irritation of the mucus membrane and consequent change, yet it is 
fair to suppose that a specific soil is required. The discharge arises 
from any bony cavity opening into the nose. The discharge and con- 
sequent drying of the secretion varies as to the extent of the parts 



236 MEDICAL SOCIETY OF NEW JERSEY. 

affected. The odor is not in proportion to the discharge. The 
retained dry secretions are at last discharged by frequent blowing of 
the nose and the formation of secretions beneath. It follows that in 
a good percentage of cases that obstinate laryngeal cough exists, 
alarming both the patient and friends. The odor varies in proportion 
to the amount of bone involvement. The destruction of bone and soft 
tissues is governed entirely by. treatment. There is no form of nasal 
ailment that has responded more to modem treatment than the 
atrophic. The treatment is but rational, the removal of all offending 
substances, done with gentleness and stimulation of the parts. The 
old insufflation of nitrate of silver has deservedly fallen into disuse. 
The use of cotton plegets gave little result with considerable annoy- 
ance. Experience has proven that the use of Icthyol in its purity, 
well applied, has placed the treatment of this distressing affection 
within the bounds of a possibility. It is a stimulating alterative, toning 
the parts and changing their functional character. The odor and dis- 
charge disappear with marked rapidity. Of course it is understood 
ihat this is not a cure. It is possible that occasionally a cure may be 
affected, but they are only modified in character. Boro glycerine, 
diluted one-half, sprayed in the nostrils, comforts and keeps the parts 
moist and clean. Constitutional treatment has no value, the rule 
being that these patients are in good health. 

Hypertrophic Rhinitis.— Woakes believes these growths are 
the result of a fibroid diathesis. One-third per cent, of all people will 
develop fibrous growths on irritation. 

The middle turbinated bone is the one most commonly affected, 
giving rise to interference with ethmoidal cells and accessory sinuses ; 
secretions are interfered with in their normal exit. Ii gives rise to 
pain by pressure on the nerve terminals and as a result increase of the 
hypertrophic congestion. 

Little can be added to the discussion of the subject either in its 
cause or its treatment. 

The superior turbinated bone, being virtually out of observation, 
leaves much doubt what part it plays as a cause. It has been sug- 
gested that obstinate frontal headaches recurring may be due to con- 
gestion of this bone and its soft tissue. The treatment of these cases 
is purely surgical, sufficient soft and hard tissue being removed to give 
as much room as possible. The cold snare is generally given the 
preference in the treatment of the soft form. The thermo puncture 



PROGRESS OF DISEASES OF THE NOSE. 237 

if the cautery is passed close to the bone, by the formation of cicatrical 
tissue binding the soft tissue down to the periosteum, preventing the 
increase of new tissue by pressure. The results by this method have 
been very good. Repeated punctures being made according to size 
of the growth. The treatment of this variety of nasal affections is 
not perfect. The soft form will return and the bony form is very apt to. 

Deviated Septum. — Deviated septum is the result of trauma- 
tisms in early life. Repeated injuries to the nose by falls in baby- 
hood, and blows at a later period in life, set up inflammatory change 
and increase in the parts. Over development takes place and the 
cartilage is pushed in the lateral direction. It is most common in 
the white, or races whose noses are most prominent. It is less 
common in the negro. His nose is flat and the bones stronger, being 
thus less liable to injury. A number of operations have heen suggested. 
Roberts advises separation of the cartilage from the floor of the nose, 
and then cutting off the cartilage in a number of places. The car- 
tilage is straightened' by force, and a steel pin introduced from the 
skin surface of the nose to the opposite side of the nares, and then 
down into the bone, thus holding the cartilage in its new position. 

Gleason has devised a method of button-holing the bent cartilage. 
He passes a saw from below upward through the maximum of the 
curve and makes a U shaped incision. He then, with the fingers, 
forces the excess of tissues through the incision, the denuded end 
protruding into the opposite nares. It is quickly done, being unique 
in its results. These two methods seem to give the best results, still 
the deviation returns more or less after time. Mechanical supports 
to retain the parts during recovery and afterward have no value, 
being irritating and disagreeable. Insufflation of stimulating and 
sootVjing powders are useless, the discharge carrying them away 
before any action can occur. The use of formal solutions for atom- 
izing have no curative value only modifying the condition and 
washing out retained secretions. It is a question whether they do 
not do as much harm as good. Medicated vapors, hot and cold, can 
be classed under the head of fads. The use of the Politzer bag to 
empty out the ethmoidal cells has been very effective. The assertion 
has been made that the antrums can be emptied in the same way. I 
think this is not possible. 

Polyps. — Nasal polyps belong to the same class as the adenoids, 
analagous as to tissue. There is nothing new in reference to their 



238 MEDICAL SOCIETY OF NEW JERSEY. 

character and growth. The tendency of either variety is to return. 
The removal of one or more gives room for the development of 
immature ones by the relief of pressure. The treatment is purely 
surgical, either by twisting or the snare. Adenoids are confined to 
children. Their growth is always systemic, a localized tissue meta- 
morphosed. They are removed by the finger nail, the finger, the 
curette or spoon forceps. 

Nasal Hemorrhages. — Supra-renal gland has made a great 
change in the treatment of nasal hemorrhages. The results are 
immediate, giving rise to no irritation or deleterious after effects. It 
can be used by insufflation, which is not so satisfactory as the aqueous 
mixture. The latter made extemporaneously and applied to the 
bleeding parts. 

As the bleeding of the idiopathic form of hemorrhage is from the 
septum, the application can be made by pressure or with a brush. 
The result is prompt. Adrenalin — the active principle of the gland — 
is undoubtedly more effective and stable. The gland remains without 
change if kept dry. Watery mixtures are useless and dangerous after 
a few hours standing. It does not interfere with the union or forma- 
tion of tissue. If the gland or its active principle is not convenient, 
the free use of vaseline, filling the nose as full as possible, repeating 
until the bleeding abates. There is no question of its efficacy. The 
suggestion made by Professor Agnew to use fat pork plugs was no 
doubt based on the same reason. Sponges cut to the proper shape 
and saturated with the vaseline and carried directly back to the pos- 
terior nares, is an excellent measure in obstinate cases. This has been 
found quite satisfactory in the vicious bleeding following diphtheria. 
As the sponge detached itself and forced its way out the protruding 
part was removed with scissors. Forcible removing would probably 
renew the bleeding. 

I have not written upon the pathological conditions mentioned in 
this little brochure as a specialist or expert but from the standpoint of 
a general practitioner of medicine, not having time to devote to 
special work. 

Report of Progress in Ophthalmology 

AND Otology. 

BY TALBOT R. CHAMBERS, M.D. JERSEY CITY, N. J. 

In ophthalmology during the past year experimental investigation 
has gone on as in the other sections. 



OPHTHALMOLOGY AND OTOLOGY. 239 

Attention is called to an exhaustive article by Henry Dixon Bruns, 
in Arch, of Ophth,, Vol. XXX, No. 6, in which he draws the 
conclusion: — 

First. — There cannot be any such disease as serous iritis. 

Second. — Descemetitis upon which the diagnosis of serous iritis was 
long held to rest, is a symptom which sometimes appears as an accom- 
paniment of a focus of acute inflammation in the iris, ciliary body or 
choroid. 

Third. — Descemetitis" may also appear in cases of uveal diseases, so 
slight and evanescent that we are unable to determine in what portion 
of the membrane the focus may be situated. In such cases we cannot 
make our diagnosis more precise than is indicated by the term incip- 
ient uveitis. 

Fourth. — More exact observation will probably show descemetis 
to be most frequently the principal symptom of an outbreak of an 
acute plastic (exudative) choroiditis. 

A valuable paper on the treatment of serpiginous ulcers of the 
cornea was read by Dr. Kipp, of Newark, before the American 
Medical Association, at Saratoga. He makes two classes. In the 
first class grayish lines surround the ulcer, there is normal cornea 
outside of it and a small hypopyon. Here recovery occurs under 
warm applications, cleansing and mydriatics. In the second class 
there are no opaque lines encircling the ulcer, the hypopyon is large, 
irido-cyclitis is intense and the tension of the eye is often increased. 
The advancing infiltrated portion of these ulcers should be destroyed 
by the actual cautery. 

Hamburger, Klin. Monatsbl, XXXVIII, claims that the liquid in 
the anterior chamber is supplied from the anterior surface of the iris. 
He states that the ciliary body is not to be regarded as a secretive 
organ. Proof is furnished by the intravenous injection of fiuorescin, 
and the equatorial section of the freshly enucleated eye. The ciliary 
body is then found almost free from the diffusible stain, but it appears 
at the surface of the iris, indicating that this is the source of the phy- 
siological aqueous humour. A direct proof of this is the fact that 
afterward the fiuorescin injections can be seen to appear on the 
anterior surface of the iris, in eyes with diminished tension. In normal 
conditions, it would seem to be the function of a ciliary body to fur- 
nish liquid for the structure behind the iris, but the greater part of the 
liquid in the anterior chamber is secreted not by the ciliary body but 
by the anterior surface of the iris. 



240 MEDICAL SOCIETY OF NEW JERSEY. 

Prof. Haab, in his paper before the American Medical Association, 
at Saratoga, stated that he employed his magnet to entice the foreign 
body through the dilated pupil. If the foreign body be fast in the 
ciliary body the magnet is so placed behind the eyeball as to draw the 
foreign body back out of its bed, and then it is slowly approached 
to the cornea from the front, as to bring the foreign body through the 
pupil. In cases of infection from a foreign body in the eyeball, Haab 
uses gelatin discs of iodoform. He inserts them in the wound of the 
eye and thinks that sometimes they have corrected infection. 

Many papers have been published on the Haab magnet, but there 
are few cases in which the Johnson magnet, introduced by out Dr. 
VV. P. Johnson, of this Society, will not do as good work as the Haab 
or Hirschberg magnet. 

Immense progress has been made in the use of the X-rays as a 
finder for locating the F. B. in the eyeball. This makes its removal a 
matter of less injury to the vitreous and other interior parts. 

The value of extirpation of the superior cervical ganglion for the 
relief of glaucoma is being most seriously considered. Ziebe and 
Axenfeld reported in the early part of the year that seventy-four cases 
had been operated upon with but one death. 

At a recent meeting of the eye section of the New York Academy 
of Medicine, Dr. Weeks showed three cases which had been operated 
upon with relief of tension in the e\e. It was interesting to note the 
first operation took two hours, done by a general surgeon, and Dr. 
Weeks thinks it may be done now in fifteen minutes. Z and A stated 
that by the operation an improvement is brought about, lasting 
several months in some eyes. In others, the progress of glaucoma is 
checked. But one cannot determine beforehand whether the opera- 
tion will be of service. In acute inflammatory glaucoma it is contra 
indicated, except where iridectomy is refused or where iridectomy on 
the other eye has not been successful. In Haemorrhagic glaucoma it 
is a justifiable experiment. In chronic inflammatory and simple 
glaucoma a series of favorable results have been obtained. 

Walter B. Lancaster, in the Arch, of Oph., Vol. XXX, No. 4, has a 
paper on the sterilization and care of instruments, which will be 
appreciated by all. He says, ** Advantages of easy availability, sim- 
plicity, speed and certainty of boiling need not be enlarged upon." 
He says, there is a general opinion that boiling injures the edge of a 
knife, and states there are four conceivable ways in which the edge of 



OPHTHALMOLOGY AND OTOLOGY. 24 1 

the knife may be injured in sterilizing by boiling : First, by oxida- 
tion, rusting; second, by mechanical injury; third, by methods used 
to remove the solution after sterilizing (A, wiping and B, immersing in 
other liquids) or by the effect of heat on the temper. Now referring 
to chemical authorities, they say iron only rusts in the presence of 
oxygen and water containing either carbonic or some other 
volatile acid or a metallic salt in solution. Again, they say liability 
to rust is diminished in the presence of alkalies. After experimenting, 
he concluded that for practical purposes bicarbonate of sodium was 
safe. A second lot of experiments show caustic potash in solution 
would keep needles untarnished for many months. He claims, that 
wiping as a source of injury is very much underestimated. As to the 
effect of boiling on the temper of knives it is nil if care be taken that 
they do not rest directly on the bottom of the vessel in which they 
are boiled ; and concludes by saying that boiling in alkaline solution 
does not rust instruments if properly done. 

Second. — That soaking them in solutions of boric acid, salt, or even 
alcohol, does harm them, and as far as I can see is entirely 
unnecessary . 

Third. — That coating with oil, which is very easily removed by 
boiling soda, is a sure preventative of rust. 

De Schweinitz calls special attention to a class of lens opacity 
which has been described by Risley and others as associated with 
changes in the chorid of a non-inflammatory character. The progress 
of these is sometimes apparently arrested by optical, local and general 
treatment. He believes, also, that cataracts which appear in diabetes, 
nephritis, lithaemia and arterial sclerosis are at times, retarded by 
measures suited to the patient's general condition, but that these 
measures never dissipate opacities already existing. 

There is no evidence, he says, that electricity has the slightest 
effect, and massage, if it has any influence, tends to hasten the opaci- 
fication of the lens. 

« 

Weeks also says that attempts to stimulate the circulation such as 
the use of massage, electricity and heat he believes only have a theor- 
etical claim for consideration, and emphasizes that no treatment can 
clear up opacities already existing. 

There is one great step in advance by which operations, however, 
cleverly done, are avoided. They leave scars with greater or less 
deformity. I refer to the dispersion of the skin cancer of the lids, 

16 



242 MEDICAL SOCIETY OF NEW JERSEY. 

a not uncommon disease, by means of the X-rays. The American 
Surgical Association has appointed a committee, to arrange for a 
symposium on X-rays for their meeting in 1903. 

Otology. — Dr. E. O. Belt, of Washington, refers to a physician 
who attached so little importance to a running ear that he told the 
family to syringe the ear with soap suds and paid no further attention 
to it till the mastoid was involved and the patient ill with pyaemia. 
His criminal carelessness had allowed this patient to go to an 
untimely grave. He also says that statistics show that between i 
and 2% of all cases of aural suppuration, terminate fatally through 
some cranical complication. In this country 4,000 deaths, which 
occur annually from abscess of the brain, are attributed to suppura- 
tion of the middle ear. 50^ of deaf mutes are due to like cause and 
20^ of pupils in our schools have defective hearing. 

It is a matter of interest to note that otology is to be taken from 
the ophthalmological section and added to the nose and throat section 
of the American Medical Association. 

Several papers and discussions are on record concerning electrolosis 
of the eustachian tube for the cure of tinnitus. Some of the experi- 
menters are very enthusiastic and report marvellous relief while 
others are less sanguine. 

The aural surgeon is becoming very much bolder and more radical 
each year, and several cases are now on record where he has invaded 
the sacred territory of the internal ear. Dr. A. Knapp, of New York, 
in the Archives of Otology, Vol. XXX, No. 2, tells how, in searching 
for the abscess of the brain which he knew to be present, he removed 
the semicircular canals and cochlea. This at a third operation. At 
the first operation the labyrinth was freely opened, finding discolored 
granulations. After the first operation the patient was allowed to 
leave the hospital, but returned in five days. The pulse which had 
been at 120 dropped to 80, the temperature remaining high and increas- 
ing stupor set in. A diagnosis was made of abscess in the cerebellum 
near the internal auditory meatus. An attempt was made to get as 
near to this region as possible ; the entire bony labyrinth was removed. 
The cerebellar dura was broadly exposed and incised, and the cere- 
bellum was freely punctured, but without success. At the autopsy, 
the abscess was found in the flocculus at a point internal and 
anterior to the internal auditory meatus — an inaccessible position. 
In Prof. Korner's third edition of his ear diseases, the number of 



OPHTHALMOLOGY AND OTOLOGY. 243 

brain abscesses operated on has been increased from 92 to 267, and 
sinus thrombosis operated on from 79 to 314. 

Dr. Schwarz, of Halle, recommends highly, lumbar puncture as an 
aid to diagnosis, i. A negative clear fluid excludes diffuse purulent 
meningitis in cases of otitis with intracranial complications. 2. The 
positive results (clouding by increased number of leucocytes and the 
presence of micro-organisms) shows the presence of diffuse purulent 
meningitis or cerebro spinal meningitis. 3. Tuberculosis meningitis. 
4. Our experience has been that sinus thrombosis has been associated 
with excessive cerebro spinal fluid. 5. Lumbar puncture, if performed 
correctly and without aspiration, is without danger. 



ADDENDUM 



TO 



REPORT OF STANDING COMMITTEE. 



I . »- 



fitt Plemoriam. 



^'^^N*- 



ALEXANDER M. MECRAY, M.D., 

Born October 3. 1839. 
Died June 26, 1902. 



W. H. C SMITH, M.D., 

Born August 2, 1848. 
Died February 12, 1902. 



GEORGE BAYLES, M.D., 

Born August 7, 1836. 
Died December 20, 1901. 



THOMAS DUNN ENGLISH, .M.D., 

Born June 29, 18 19. 
Died April i, 1902. 



HENRY RACE, M.D., 

Born February 23, 18 14. 
Died April 20, 1901. 



fitt Mtvxoxiam. 



MATHIAS ABELL, M.D., 

Bom January i, 1830. 
Died May i, 1902. 



HENRY R. BALDWIN, M.D., 

Born September 18, 1829. 
Died February 3, 1902. 



HENRY G. WAGONER, M.D., 

Born August 16, 1829. 
Died July i, iqoi. 



GEORGE M. SWAIM, M.D., 

Born November 16, 1844. 
Died April 26, 1901. 



•.»■■*«•■ » • 



OBITUARIES. 



ALEXANDER M. MECRAY. 

BY E. A. Y. SCHELLINGER, M.D. 

While the State Medical Society was in session at Atlantic City, in 
June, the death of Alexander M. Mecray was announced to his 
nunierous friends there. It occasioned a feeling of much sadness, for 
the kind and genial physician had many friends at the meeting. He 
was a man who commanded respect and invited friendship. When 
differences occurred among his fellow practitioners, his was the char- 
acter of a peacemaker. His influence, if brought to bear at all, would 
be exerted to make the breach between enemies less wide. His consid- 
erate and respectful demeanor to the young physician always made 
the young man his friend. There was reason then for the sincere 
feeling of sadness which spread over us when we heard of his death, 
suddenly, on the 26th of June, 1902 ; cerebral hemorrhage, we were 
told, was the cause of his death. The Camden District Medical 
Society met and voted to attend his funeral in a body. The burial 
took place on the 28th, in Colestown Cemetery, where many floral 
tributes of respect were left from the numerous societies of which he 
was a member. 

Alexander M. Mecray, M.D., was born at Cape May, N. J., October 
3d, 1839. He studied medicine with Dr. Alexander Marcy, of 
Camden. In the year 1861, he entered the medical department of 
the University of Pennsylvannia, and graduated in March, 1863. He 
began practice in Cape May Court House, and historytalso tells us, 
in 1863, in Civil War times, he was warranted a medical cadet and 
assigned to duty at the Satterlee Hospital. In i860, he had graduated 
in pharmacy from Philadelphia College of Pharmacy, so in 1866, he 
purchased the drug store at Fourth and Pine streets, Camden, N. J., 
and here he made his start in Camden, as a physician. Later he 
removed to North Camden, where at 327 Cooper street,} he practiced 
medicine many years, becoming one of the city's most successful 
practitioners. He always attended closely to business and was 



250 MEDICAL SOCIETY OF NEW JERSEY. 

talking of retiring from practice when, three years ago he was sud- 
denly stricken in his office with a light stroke of apoplexy which 
necessitated his giving up practice and retiring to his farm at Maple 
Shade. There he enj6yed the close assodiation of his family, occa- 
sionally making visits to his old friends until his death. He held 
many positions of honor in this city. In 1870, he was superintendent 
of public schools. In the same year he was elected a manager of the 
Camden City Dispensary, and was a manager at the time of his 
retirement from practice. In 1867, he became a member of the 
Camden County Society, having previously joined the Camden City 
Society. In both of these societies he filled the position of president. 
He was a member of the Medical Society of New Jersey and also of 
several lodges. In 1876, he delivered his address on "Quackery" 
before the Camden City Medical Society. On June 22d, 1887, when 
the Cooper Hospital opened, he was elected on the medical staff, and 
continuously filled that position with honor, until failing health caused 
him to give up all professional work. 



W. H. SMITH, M.D. 

Dr. Smith was born August 2d, 1848, in Philadelphia, Pa. He was 
the son of Dr. William P. and Harriet E. Smith. His grandfather was 
the Rev. Asa Smith, one of the pioneers of Methodism, who, during 
the greater part of his life, was a circuit rider in this section of New 
Jersey. He died in harness and his remains are intered at Penn's Grove. 
Dr. Smith was educated in the schools of Philadelphia, was a graduate 
of the High School, and while a student there he commenced the study 
of medicine with his father, and also attended medical lectures at the 
University of Pennsylvania. While thus engaged in study the civil 
war broke out and the demand for surgeons was so great that he 
offered his services to the government, was accepted, and entered 
upon hospital work. In 1863 he was appointed Acting Assistant 
Surgeon at Satterly Hospital and soon attracted attention by the 
modest but efficient manner in which he performed his duties. 

In 1864 Dr. Smith returned to his studies at the University and was 
graduated in 1866. He opened an office and practiced for a time in 
Philadelphia. In 1868 he was united in marriage to Miss Artemisia 
Mulford, of Millville, N. J. and settled in that city. 



OBITUARIES. 251 

The Doctor relinquished the practice of medicine for a time to enter 
the Millville National Bank as teller. This, however, proved not to 
be congenial, and he again resumed the practice of medicine, opening 
an ofiice in Cedarville. He soon returned to Millville where he coif- 
tinued to practice his profession until his death, February 12th, 1902. 
He was a permanent member of the Medical Society of this state, and 
Secretary of the United States Board of Medical Examiners. 

Civil honors were frequently offered to Dr. Smith, but his profession 
demanded and received his time and best efforts. He was for several 
years Superintendent of Public Schools. In Masonry the Doctor was 
distinguished, being Past Master of the Salome Lodge, of Cedarville, 
and Shekinah Lodge, of Millville. He was also Past High Priest of 
the Richmond Chapter, and Past Commander of the Olivet 
Commandery. 

Dr. Smith will be deeply and sincerely mourned by the many fami- 
lies to whom he has ministered. 



GEORGE BAYLES, M.D. 

BY THOMAS W. HARVEY, M.D. 

Dr. George Bayles died on December 20th, 1 901, at his residence, 404 
Main Street, Orange, N. J. He had had diabetes for some time and 
died in coma. He had been able to attend to his professional work 
up to the last week of his life. 

Dr. Bayles was born in New York in 1836, there he was educated, 
taking his medical degree in 1859, at the College of Physicians and 
Surgeons. His family, however, came from New Jersey originally, 
there being a large connection in Morris and Mercer counties. 

The Doctor's preceptors were Dr. Edward Delafield, then president 
of the college, and Dr. Markoe, of the Staff of the New York Hospital. 
After his graduation he was appointed curator of the pathalogical 
department of the New York Hospital, where he also served as interne . 
After a year as surgeon to the packet ship Manhattan, plying between 
Liverpool and New York, he was appointed resident physician to the 
New York Eye and Ear Infirmary. 

In 1862 he was appointed Assistant Surgeon, and later. Surgeon 
with the rank of Major to the 4th New York Volunteers, Heavy Artil- 



252 MEDICAL SOCIETY OF NEW JERSEY. 

lery. He saw service in and about Washington, his regiment having 
been distributed among the chain of forts situated about that city. 
His daily tour of duty covered over sixteen miles of territory. In 1863 
he was advised to resign on account of his health, which he did and 
returned to New York. Recovering his health he again entered 
the service as a Contract Surgeon, serving during 1864 and 1865 in 
various hospitals near Washington and in New York harbor, until the 
end of the war. 

In 1865 he commenced private practice in Irvington, N. Y., where 
he remained until 1870, during which time he served as Sanitary 
Inspector of the Metropolitan Board of Health, and was elected Presi- 
dent of the Westchester County Medical Society. 

From 1 87 1 to 1880 he practiced his profession in New York City, 
and lectured before the Training School for Medical Missionaries, and 
served on the staff of the Northwestern Dispensary. In 1 880 he re- 
moved to Orange, was elected on the staff of St. Barnabas Hospital in 
1 88 1, and in 1884 he was elected to the staff of the Orange Memorial 
Hospital. He continued in that service until his death. He also was 
appointed Medical Director of the House of the Good Shepherd. 

Dr. Bayles became a member of the Essex District Medical Society 
in 1 88 1, was elected vice-president in 1895 and president in 1896. In 
1897 he was elected permanent delegate of the State Society. He 
also received the Fellow's prize in the same year. 

He was a member of the Orange Mountain Medical Society and of 
the American Medical Association, also a resident Fellow of the 
Academy of Medicine. 

He attended the Tenth International Medical Congress as a del- 
egate from the academy, where he read a paper prepared by Thomas 
A. Edison, on electrolysis. 

When the Spanish War began he offered his services to the Govern- 
ment, and was appointed surgeon with his old rank of major and 
placed in charge of the hospital at Fort Hancock, at Sandy Hook. He 
remained there until the close of the war when he returned to private 
practice. The estimation in which he was held as a physician is 
evidenced by the honorable positions that he held in medical societies 
and public institutions, as a citizen, by his election as president of 
the Board of Education for two terms. He was an earnest and 
faithful physician, a courteous and congenial colleague and an upright 
and patriotic citizen. 



OBITUARIES. 253 

THOMAS DUNN ENGLISH, M.D. 

BY CHARLES YOUNG. M.D. 

• 

Thomas Dunn English was born in Philadelphia on the 29th of 
June, 18 1 9. His parents were born in New Jersey. Before his birth 
his parents had espoused the religion of the Quakers. They desired 
that the boy should study medicine, and he was sent early in life to 
the Friends School, at Burlington, New Jersey, to receive his preparr 
atory training. When he was sixteen years of age, business reverses 
compelled his father to remove him from school. At this early age, 
the boy became a journalist, writing editorials for Poulson's Adver- 
tiser and other Philadelphia newspapers. His desire to be a physician 
continued without abatement, and after considerable experience in 
journalism he entered the office of Dr. Paul D. Goddard, and finally 
received the degree of doctor in medicine from the University of 
Pennsylvania. He was graduated in 1839. In accordance with the 
wishes of his father, the boy, during his spare hours and in school 
and college vacations, applied himself diligently to learning the trade 
of carpentry. 

The doctor always took much pride in his skill in the various 
branches of the trade, and the thoroughness with which he had 
mastered them. Immediately after graduation in medicine. Dr. 
English began the study of law, and was admitted to the bar in 1842. 
He first appeared in public about the time of receiving his medical 
doctorate, and became somewhat prominent in his agitation^ f or the 
admission of Texas to statehood. Before he was twenty-five years 
of age, he publicly debated this question, having for his opponent a 
member of Congress from Georgia. During the Polk campaign 
for president, he became prominent in the counsels of his party, 
editing a newspaper and being president of a political organization. 
After election he had much influence with the administration, and 
was accorded the privilege of the floor in both houses of Congress. 
During the decade from 1842 to 1852, Dr. English devoted his literary 
energies to the drama. He wrote a number of plays for the promi- 
nent theatres of Philadelphia. He preserved the manuscripts of few of 
the plays. In 1852, Dr. English Removed to Western Virginia, where 
he remained for five years. During this time he paid little attention 
to literature, but rode the circuit, and practiced medicine and surgery, 
carrying both law books and surgical instruments in his saddle bags. 



254 MEDICAL SOCIETY OF NEW JERSEY. 

Many times he argued a case at law and performed a capital oper- 
ation in the same day. In 1857, Dr. English came to New York and 
the following year he removed to Hackensack Township, Bergen 
County, New Jersey. Since then, with the exception of one year, he 
was a resident of New Jersey until his death. He was always prom- 
inent in politics and took an active part in the fight which led to the 
disruption of the Democratic Party and the election of Abraham 
Lincoln. During the war, he represented his district in the Legisla- 
ture of New Jersey. . In 1878, Dr. English removed to Newark and 
soon became identified with its interests. In 1890, he was elected to 
represent the district in Congress, and two years later he was 
re-elected. In 1894, he was renominated by his party, but was 
defeated at the polls and never afterwards held public office. Both in 
the legislature of the State and in the halls of Congress, his was an 
intellect always to be reckoned with. He was fond of controversy 
and ready and forceful in debate. His literary reputation will be 
sustained by many lyrics, especially by " Ben Bolt," of which he always 
spoke slightingly, and by a series of poems published during the 
Civil War, and afterward collected and published in book form under 
the title of " Battle Lyrics." Dr. English did not seek practice in 
medicine during his residence in Newark, but early joined the Essex 
District Medical Society, and was a regular attendant at its meetings. 
In questions of ethics, he vigorously maintained and defended pro- 
fessional courtesy and honor, and opposed any infraction of the code. 
In 1900, in consequence of failure of sight and bodily feebleness, he 
resigned from the Society, but was forthwith elected an honorary 
member. He died April i, 1902. 



HENRY RACE. A.M.. M.D. 

BY G. N. BEST, M.D. 

The subject of this sketch, son of Jacob Race and Sophia Hoff. was 
born in Kingwood Township, Hunterdon County, New Jersey, Feb- 
ruary 23d. 1 814, and died at Pittstown, N. J., April 20th, 1901. His 
early education was acquired in the ' neighboring schools and under a 
private tutor. Entering Lafayette College in the class of '42, he re- 
mained two years at this institution, which in 1871 conferred on him 
the honorary degree of Master of Arts. 



OBITUARIES. 255 

Dr. Race began the study of medicine under Drs, Abernethy and 
Southard, of Belvidere, and was graduated from the medical depart- 
ment of the University of Pennsylvania in 1843. Soon after gradu- 
ation he located at Pittstown, where he remained, with the exception 
of two years spent in California, until his death, engaged in more or less 
active practice of his chosen profession. In 1848 he joined the Hunt- 
erdon County District Medical Association, and, in 1857, married Ada 
L. Woodruff, by whom he had three children, one son and two daugh- 
ters, all of whom survive him. 

Dr. Race was a man of scholarly habits, fine attainments and of strong 
convictions. He was a member of the Presbyterian Church, and for 
many years a ruling elder. From the formation of the Republican 
party to the close of the civil war he took a lively interest in politics, 
contributing numerous articles to the local press on the leading issues 
of those thrilling times. During the latter part of his life local history 
received his attention. In this department he was a recognized 
authority, his contributions being models of style and of patient re- 
search. He was an active member of Hunterdon County Historical 
Society, Historical Society of New Jersey, and an honorary member of 
the Historical Society of Pennsylvania. 



HENRY RUTGERS BALDWIN, M.D., LL.D. 

BY DAVID C. ENGLISH, M.D. 

Dr. Henry R. Baldwin was born in New York City, September 
1 8th, 1829, and died at New Brunswick, N. J., February 3d, 1902. 

He was the son of Rev. EH Baldwin, M.D., D.D., and Phoebe 
Van Nest. His ancestors were Hollanders on the maternal side, and 
paternally were among the original settlers of 1639 in the State of 
Connecticut. In early life Dr. Baldwin came to New Brunswick 
with his parents and entered the " grammar school " connected with 
Rutgers College; later he entered the college and, completing the 
regular course, received the degree of Master of Arts, in 1849. 

Soon after graduation he began the study of medicine with Dr. 
George J. Janeway, of New Brunswick, and later with Drs. Willard 
Parker and Robert Watts, of New York City. In 1850, he entered 
the College of Physicians and Surgeons (Columbia), New York City, 
and received his degree of M.D. from that institution in 1853. For 
six months thereafter he was clinical assistant to Dr. Robert Watts, 



256 MEDICAL SOCIETY OF NEW JERSEY. 

Professor of Anatomy in the College of Physicians and Surgeons, and 
he was also on the medical staff of Bellevue Hospital, serving about 
eighteen months as a resident physician at the hospital. In October, 
1854, he commenced the practice of medicine at Stapleton, Staten 
Island, as assistant to Dr. William C. Anderson, but failing health 
compelled him to leave there, and he became surgeon of the Steam- 
ship Baltic, of the Collins Line, between New York and Liverpool. 

In December, 1855, Dr. Baldwin settled in New Brunswick. N. J., 
where his scientific attainments and devotion to his profession soon 
secured him a good and lucrative practice which continued to increase 
until it became so extensive that he needed some relief from its 
exacting duties. This relief he was privileged to secure October i, 
1883. when he associated with himself in practice, his son, Dr. A. Van 
Nest Baldwin (Class of 1882. College of Physicians and Surgeons, 
New York), and this partnership continued until the death of the son, 
February 14. 1897. The doctor was a conservative practitioner. 
Ever a close student, he kept posted on the progress in the science 
and art of his profession, but he was not willing to abandon old 
methods of practice which had given perfectly satisfactory results 
unless new theories and methods commended themselves to his judgment 
as scientific and rational and had given or promised better results. 
Especially was this the case in his practice of surgery. He was ever 
an able and successful surgeon, but he did not believe in what he 
designated as the tendency of these later years to the *' too free use 
of the knife." 

Dr. Baldwin ever took a deep interest in the work and progress 
of the medical profession, and his high sense of honor, and of the 
dignity of the profession ever led him to a rigid adherence to the code 
of medical ethics, and in his intercourse with the members of the 
profession he was considerate and obliging, ever willing to sacrifice 
time and comfort, especially in helping the younger members. 

He was one of the most faithful members of the Middlesex County 
District Medical Society, of which he was secretary in 1857, and 
president in 1 862-64 ; was frequently appointed one of its delegates to 
me State Society, and three times to the American Medical Associ- 
ation. He was also one of the most active and esteemed members of 
the Medical Society of New Jersey; was its treasurer from 1866 to 
1874, finding its treasury overdrawn he inaugurated the creation of a 
fund which amounted to more than $1,300, when he was honored in 



OBITUARIES. 257 

187^, by election as third vice-president of the Society, advancing to 
second vice-president, in 1875, and first vice-president, in 1876. He 
was in June, 1877, elected president of the Society, serving, according 
to custom, one year, and thereafter became a Fellow of the Society, 
since which time he served fourteen years as Chairman of the Business 
Committee, and for several years as a member of the Fellows' Prize 
Essay Committee, two ye«irs as its chairman. 

Dr. Baldwin was also a member of the Society of Internes, of 
Bellevue Hospital, New York City; of the American Academy of 
Medicine ; the American Medical Association ; the New Jersey State 
Microscopical Society, and a trustee thereof ; the New Jersey Sanitary 
Association, and of its executive council. 

He was appointed by (iov. Griggs, in May, 1897, a member of the 
board of managers of the State Hospital for the Insane, Trenton, 
was chairman of the medical committee of the board, and one of the 
most active and efficient members of the board. 

He was for more than twenty-five years surgeon of the Pennsyl- 
vania railroad for this section ; was president of the medical staff of 
the John Wells Memorial Hospital, at New Brunswick, from its 
organization in 1889, until his death. He was also president of the 
City Board of Health from its organization, until his death, and the 
successful prosecution of its work was in large measure due to his 
watchful oversight and prompt and decisive action in times of 
threatening or prevailing epidemics. ( 

During Dr. Baldwin's professional life in New Brunswick, of more 
than forty-six years about fifty students entered the profession from 
his office, several of whom are now practicing medicine either in this 
city, county or state. 

It will thus be seen that Dr. Baldwin led an exceedingly active and 
laborious life, and he served his patients and the various organizations 
with marked ability and fidelity, yet the large demands of these pro- 
fessional services did not prevent him from taking an active interest 
in public affairs. On all questions that related to society he studied 
and sought the public good. He was for two terms a member of the 
Board of Alderman, and also of the County Board of Freeholders, 
was active in the establishment and management of the City Water 
Works, serving for twelve years as a member of the Board of Water 
Commissioners. He was also a member of the City Board of Edu- 
cation for seventeen years and its treasurer, from 1859 ^o 1861. 

1 7 



258 MEDICAL SOCIETY OF NEW JERSEY. 

On June 17, 1884. he was nominated by the Alumni Association, 
and elected a trustee of Rutgers College for five years, and re-elected 
for a like term in 1889; on March 6, 1894, he was elected by the board 
of trustees one of its life members. In 1893, the College conferred 
upon him the honorary degree of Doctor of Laws. 

Judge H. W. Bookstaver, LL.D., of New York, one of the trustees, 
in his annual address before the Alumni Association of the College, 
this year, paid a tender and eloquent tribute to his memory, in which 
he referred to the great value of Dr. Baldwin's services to the College 
and to the cause of education, and Dr. Baldwin's friends have recently 
erected to his memory large and beautiful gates at one of the 
entrances to the College grounds, on which, with the College motto, 
are the words: " In honor of Henry Rutgers Baldwin, M.D., LL.D., 
Loyal Alumnus and Faithful Trustee. These gates are placed here 
by his friends." Df. Baldwin was also an active member of the Phi 
Beta Kappa Society, connected with the College; also, an active 
member of the New Brunswick Historical Club. 

He was also identified with some of the manufacturing industries 
of the city, among which were the New Brunswick Rubber Co. and 
the Consolidated Fruit Jar Co.. serving both as a director many years. 

The doctor was in politics a Democrat, a strong Democrat of the 
best type— loving country and the right above party. He was a man 
of sterling integrity, with a mind naturally critical. He searched for 
truth and was quick to take his stand for the right as he conceived it, 
and as persistently and unalterably opposed the wrong, whether these 
questions of right and wrong related to professional, educational, 
moral or municipal matters ; perhaps most so in political matters, for 
he hated jobbery, corruption and dishonor, which he fought, not only 
individually, but through the City Club which he was instrumental in 
organizing, and of which he was the most active leader. It made no 
difference to him whether his antagonist was a Democrat or Repub- 
lican in name, and we know he frequently voted for a Republican 
where he could not conscientiously vote for his party's candidate. He 
proved himself a true citizen, speaking, working, fighting and voting 
for civic righteousness. 

Dr. Baldwin made a public confession of his faith in the Lord Jesus 
Christ in 1853, when he united with the Second Reformed Church, of 
New Brunswick; he served his church several terms as deacon and 
elder, and he was a liberal contributor to religious institutions and 
benevolent organizations. 



OBITUARIES. 259 

Dr. Baldwin was married December 27, 1855. to Elizabeth Van 
Cortlandt Rutgers, daughter of Anthony Rutgers, of New Brunswick, 
and they had eight children, five sons and three daughters. His wife 
died in 1888. Two sons and two daughters still survive. 

Dr. Baldwin had been for many years a sufferer from rheumatism ; 
during the last year he had several attacks of angina pectoris and the 
last one was complicated with pneumonia and caused severe suffering 
and ended in death on the morning of February 3, 1902. His funeral 
services were held in the Second Reformed Church, New Brunswick, 
which was crowded to its utmost capacity, several Fellows of the 
State Medical Society and other prominent physicians from the State 
and New York City, being present. The members of the Middlesex 
County Society attended in a body. This latter Society, at a meeting 
held on February 6th, unanimously adopted the resolutions as given 
below. By the death of Dr. Henry R. Baldwin, the profession has 
lost an able and devoted practitioner ; his patients, a physician and 
friend, whose skill and fidelity merited and received their entire con- 
fidence ; the cause of education, a wise and earnest advocate and an 
untiring worker ; the cause of religion, one who lived and adorned it ; 
the community and State, a public-spirited citizen, who guarded the 
public health, physical and moral, and who sought to advance civic 
righteousness and material prosperity ; and the family, its wise, 
true, loving and devoted head, a loss its members can best know and 
will continue keenly to realize. 



RESOLUTIONS OF THE MIDDLESEX COUNTY DISTRICT MEDICAL 

SOCIETY. 

Whereas, The Society has learned with profound sorrow of the 
death of an old and honored member, Henry R. Baldwin, M.D., 
LL.D' . therefore, 

Resolved, That while bowing in submission to this sad Providence 
and gratefully acknowledging His goodness, in giving us such a 
manly, courageous, Christian gentleman and physician, and sparing 
him to us so long, granting him frequent restorations from severe 
illness during his later years, we cannot but express our deep sorrow 
in parting witH our deceased brother. Dr. Baldwin's professional 
attainments were of the highest order and secured him recognition as 
the head of the profession in the community and prominence in the 



26o MEDICAL SOCIETY OF NEW JERSEY. 

State Medical Society, in which his executive ability was markedly 
shown during his incumbency as treasurer tor eight years, and the 
esteem in which he was held by his fellow-members led to his election 
as president, in 1877, and thus he became a Fellow of the State 
Society. His ability and assistance were ever most cheerfully and 
promptly given at the call of his brethern in their times of need. 

Resolved, That in his faithfulness to the sick and in his conscien- 
tious, self-sacrificing devotion to the labors of his profession our 
brother has left us an example of fidelity to the claims of duty and to 
opportunities for usefulness, which commands our unqualified admir- 
ation and respect, and is worthy of our constant emulation. 

Resolved, That in giving expression to the deep sense of loss which 
we and the profession at large have sustained, we also emphasize the 
fact that both city and state have lost a public-spirited citizen, an 
efficient officer, who continually guarded the public health and strove 
to conserve and advance the highest interests of the people in educa- 
tion, morality and good government. 

Resolved, That the members of this Society attend his funeral in a 
body in testimony of their high appreciation of the worth of one 
who ever stood forth as a defender of the ethics, dignity and useful- 
ness of the profession, and of their sincere regard for the memory of 
the deceased. 

Resolved, That to his bereaved family we tender our heartfelt 
sympathy, invoking for them Heaven's choicest consolations, and 
assuring them that we shall ever cherish in our hearts the memories 
of his earnest and devoted life. 



HENRY G. WAGONER. 

BY J. P. HECHT. 

Dr. Henry Gatzmer Wagoner, son of William and Elizabeth 
(Gatzmer) Wagoner, was born in Hunterdon County, August i6th, 
1829. He secured a common school education and taught school for 
a year and a half. He studied medicine with Dr. John Manners, in 
Hunterdon County, and {graduated in 1853 from the University of 
Pennsylvania. He commenced practice at Stanton in his native 
county and removed to Somerville in 1859, where he remained in 
active practice till the day of his death. Dr. Wagoner died of 
apoplexy, at his home, after a few hours illness, July ist, 1901. The 



OBITUARIES. 261 

experience of nearly a half century of general practice made him the 
valued consultant of many of his younger associates. Of his kind- 
ness, friendliness and geniality, his professional brethren, the 
members of the many families he served and his fellow-townsmen are 
the witnesses. While at Stanton, Dr. Wagoner was a member of the 
Hunterdon County District Medical Society; when he cam6 to 
Somerville he joined the Somerset County District Medical Society, 
and remained a member until his death. He served the Society in 
various positions and was its president for many years. He was the 
first permanent delegate to the Medical Society of New Jersey from 
Somerset County Society, and president of the medical and surgical staff 
of the Somerset Hospital at the time of his death. Among the many 
other positions of honor and trust held by Dr. Wagoner during his 
residence in Somerville. we recall, that he was County Physician for a 
number of terms, member of State Board of Medical Examiners for 
two years, and one year its president ; president of the Board of 
Pension Examiners, during the administration of President Arthur, 
and for five years lay judge of the County Court. Dr. Wagoner was 
a member of all the local and State masonic bodies and filled some of 
the highest offices in the gift of the fraternity. From a local news- 
paper we copy this truthful and graceful tribute : '* The sudden death 
of Dr. Wagoner removes from our midst one who has long been a 
resident of our town, and who. by his suave and pleasant ways had 
endeared himself to all. Dr. Wagoner had no enemies. He was 
always ready to lend a helping hand, and his genial fellowship lifted 
many a desparing soul above the plane of his sorrows." 



GEORGE MATTHIAS SWAIM, M.D. 

Dr. George Matthias Swaim was born in Newark, N. J., November 
i6th, 1844, and died in Roosevelt Hospital, New York City, April 
26th, 1 90 1, where he had been under treatment for cancer, for nearly 
two months. His father was Ezra Baldwin Swaim, and mother, Mary 
Jane Cross, and grandfather, Matthias Swaim, of Washington Place, 
now called. Cheapside, near Chatham. 

Dr. Swaim attended the Twelfth Ward Grammar School in Newark, 
in his boyhood days, after which he was clerk in a drug store. In 
1862, he enlisted in Company D, Thirteenth Regiment, New Jersey 
Volunteers, for three years, and, at the end of service was honorably 



262 MEDICAL SOCIETY OF NEW JERSEY. 

discharged. He then went to Philadelphia and studied in the Phila- 
delphia College of Pharmacy, graduating March 14th, 1867. He was 
also a graduate of Columbia College of Physicians and Surgeons* 
receiving his diploma in 1870. Dr. Swaim studied with Dr. William 
O'Gorman, in Newark, N. J., and practised there for a short time. 
On September 2d, 1875, became to Chatham, practicing his profes- 
sion, and in 1887, he built and opened a drug store, which business 
he carried on till his death. On October 17th, 1894, he married Miss 
Louise G. Purdy, who survives him. 

Dr. Swaim was of a modest and retiring disposition. Those whom 
he served, speak of him as being one of the most kind and sympa- 
thizing of physicians. Many of his patients in poor circumstances 
received attention, for which he seldom or ever sent a bill for services ; 
and many tears were shed at his death by the poor, who will miss a 
kind friend. In his earlier years he united with the Methodist 
Church in Newark and was a conscientious man to the day of his 
death. 



MATHIAS ABELL, M. D. 

Mathias Abell was born in Flemington, Hunterdon County, N. J., 
on January ist, 1830. His early education was begun in his native 
place and completed at the Academy in New Hope, Pa. After 
spending a few years in teaching, he entered the office of Dr. John 
Blane, one of the most prominent physicians in Hunterdon County, and 
began the study of medicine He afterwards entered the College of 
Physicians and Surgeons, New York, from which he graduated in 
1856, with high honors. He spent one year among the hospitals of 
New York and then returned to the vicinity of his former home 
and entered upon a general practice of medicine at Quakertown, 
Hunterdon County. He at once (1857) joined the County Society 
and was chosen for its president in 1863. He was several times a 
delegate to the State Society, and during the quarter of the century 
that he remained at Quakertown, he built up an extensive practice 
and was highly respected throughout the community. The territory 
which he was obliged to cover made too great a strain on his physical 
resources and he decided to concentrate his abilities in a city practice. 
He, therefore, in 1883, removed to Providence, Rhode Island, where he 
spent the remainder of his life. He was a member of the Rhode 



OBITUARIES. 263 

Island Medical Society and was elected an honorary member of 
Hunterdon County Society in 1883. Although not in robust health 
for several years his last sickness was of short duration and he died at 
his home in Providence, on May i, 1902. He leaves a widow and one 
daughter. The following excerpt from the Providence Daily Journal^ 
is an appropriate tribute to his memory : "As a practitioner he 
(Dr. Abell) was devoted to his profession, and was always ready to 
undergo any sacrifice for the benefit of others. He was fond of his 
home and was a kind and loving husband and father." 



REPORTS OF DISTRICT SOCIETIES. 



ATLANTIC COUNTY. 

To the Chairman of the Standing Committee, etc.: 

The District Society has held its regular meetings throughout the 
year. These meetings have been fairly well attended and quite a little 
interest shown. The Board of Health has been taking especial care 
to enforce its laws in Atlantic City. The sanitary conditions have 
been watched very closely, and a house-to-house inspection carried on, 
with a view of further securing the best standard. The Water 
Department has also increased its water supply by replacing the for- 
mer main by a new and much larger one, thus insuring an abundant 
supply at all times and for all emergencies. 

Vaccination was rigorously insisted upon in all the schools as well 
as upon all residents. Three cases of tetanus developed. In all 
antitetanic serum was used, but two were seen rather late and the 
data are rather vague. On Nov. 13th, P., male, white, age 7 years, was 
admitted to the City Hospital, twenty-four hours after the first symp- 
toms developed, he having been vaccinated fourteen days previous. 
(See report). No epidemics have been reported throughout the 

county. 

Very truly, 

A. B. SHIMER, Reporter, 

The report of case being kindly furnished by Dr. F. C. Katherman, 
resident physician. 

Tetanus Case — H. P., aged 7, school boy, American, white. Cause 
of tetanus, ulcer of vaccination. Glycerinized lymph used. Vaccin- 
ated Oct. 31, I901. Admitted to hospital Nov. 13, 1901. Symptoms 
showed themselves twenty-four hours before being admitted— as pain 
in jaws, which were stiff; there was general rigidity, inability to 
swallow. On being admitted jaws were set. opisthotonos existed ; 
said he had very little pain. Temperature 101° F., pulse 104, respir- 
ation 20. 

On admission, Nov. 13, 1901, at 10:45 P* M., 10 c. c. antitoxins 
were given, He perspired freely and coughed frequently. Atropin 



266 MEDICAL SOCIETY OF NEW JERSEY. 

i-ioo and codeine i-8 were given to relieve cough and perspiration. 
Patient conscious. On Nov. 14, 9:45, 10 c. c. antitetanic serum given, 
also turpentine enema for the distension of bowels. Temperature 
during 14th 100°, pulse 100 to 130. respiration 32 to 44; was restless, 
slept in naps. At 5 P. M. 10 c. c. serum was again administered ; 
also at II P. M. 10 c. c. P. D. & Co.'s used. Micturated freely and 
voluntarily. On Nov. 15, '01, temperature rose to 101.6** F. at i 
P. M.. at 4 P. M. to 104.2° F.; passed gaS during day ; slept some, in 
naps. At 2 P. M. 10 c. c. serum; also at 11 P. M. 10 c. c. Pulse 
grew very weak ; given sparteine, digitalis, etc., as stimulants to heart ; 
frequent micturition of several ounces. Patient was able to swallow 
during the entire time, but did so very slowly. The jaws became 
relaxed, was able to protrude tongue. The opisthotonos was not so 
marked; seemed improved as to spotic condition, but pulse was 
weaker, respiration 40 to 70. On Nov. 18, '01. temperature 104° F. 
during A. M., at 1:30 P. M. rose to 105.6°, repiration 76. Death at 
1:30 P. M. 

The boy was a fairly well nourished child. The wound was kept 
fairly clean. He gave a history of playing around livery stables. The 
ulcer was simply kept clean while in hospital. 



BERGEN COUNTY. 

To the Chairman of the Standing Committee : 

Regular quarterly meetings of the Society have been held through- 
out the year and they have been fairly well attended. I am sorry to 
say that your reporter has been left very much to his own devices in 
making this report. While the members display the greatest inter- 
est in the meetings, and in all that pertains to the Society they give 
little or no assistance to the reporter in his yearly report. Our Society 
numbers thirty-six and I have received but two responses to my 
circular blanks which I sent to every member, consequently my 
report must be more of a personal one, confined to this immediate 
vicinity, rather than a report of the county, as it should be. I wish 
that something could be done to arouse the members to assist the 
reporter in his work, otherwise this report will fall far short of the 
purpose for which it was intended. 



REPORTS OF DISTRICT SOCIETIES. 267 

At each of the quarterly meetings papers of much interest have been 
read, and I regret that none of them have come to my hands for pub- 
lication, either as separate essays or to be incorporated in this report. 

Considerable interest has been added to our meetings by the essay- 
ists who are appointed at the annual meeting, and who read essays at 
each of the quarterly meetings. 

We have not added any new members to our roll, neither have we 
any deaths to report during the past year. 

Bergen County has enjoyed a particularly healthy year. There is 
nothing of unusual interest to report. The prevailing diseases have 
been those incident to the season and we have been remarkably free 
from epidemics. 

Dr. L. B. Parsell. Closter, reports an unusually healthy year. He 
also reports six cases of smallpox, one at Harrington Park, N. J., in 
a boy seven years of age, who had been previously vaccinated, and 
five other cases at Creskill, N. J., where the mother and four children, 
representing the entire family were stricken. The mother who was 
four and one-half months pregnant succumbed to the disease. The 
cases were all of the discrete variety, except the mother's, whose Case 
assumed the confluent form. Two children in the family at Har- 
rington Park, who were vaccinated early, escaped the disease, and 
three children in the family at Creskill, who were vaccinated after 
exposure, had the disease in ^ very mild form. Dr. Parsell says : 
** I wish to place on record my unqualified endorsement and approval 
of vaccination as an efficient preventive or modifier of smallpox." 

Dr. B. D. Stone, Westwood, reports malaria, rheumatism, measles 
and pertussis prevailing throughout the year. He also reports that 
there have been no epidemics in that locality during the past year. 

Those who have expressed any opinion on the subject for discus- 
sion at the annual meeting of the State Society regard isolation and 
disinfection as the best means to prevent the spread of tuberculosis. 

J. W. PROCTOR, Reporter, 

Englewood, N. J., June 13th, 1902. 



BURLINGTON COUNTY. 

To the Chairman of the Standing Committee : 

At the beginning of this short report I wish to make acknowledge- 
ment to the members of our District Society for their liberal response 
to my circular of inquiry. Out of thirty members fourteen have taken 



268 MEDICAL SOCIETY OF NEW JERSEY. 

pains to write — a number so large and unusual as to merit reward. 
In previous years five or six was the utmost limit. 

From these reports it would appear that the past year has been 
exceptionally free from severe sickness. Perhaps the most noteworthy 
fact is the almost complete disappearance of epidemic influenza. For 
the first time since the 1889 a winter has passed by without a consid- 
erable amount of it. and reports from all sections of the county either 
note its total absence or say they have had only a few mild cases, and 
that in no instance did it show its old-time severity. In view of the 
marked effect of this disease in lowering vital resistance and in expos- 
ing its victims to all sorts of subsequent infection, its disappearance 
must have a marked effect in decreasing the sum total of disease, and 
would partially account for the exceptional healthfulness reported. 

In common with the rest of the United States, our county has had a 
few cases of smallpox. Thirty in all have occurred during the year, 
of which two have been fatal. I have obtained the vaccination his- 
tory of these cases, and find that out of the thirty, only three had ever 
been successfully vaccinated (omitting two vaccinated a few days pre- 
vious to the appearance of the eruption). Of these three, one had 
not been vaccinated successfully for thirty years, one for about twenty 
years, and one only four weeks previous. The latter had a very mild 
abortive attack. While it is scarcely necessary to produce evidence 
of the efficacy of vaccination in controlling this disease, it is interest- 
ing to point out that on account of its prevalence in adjacent cities, a 
very large proportion of our population have recently been vaccinated, 
and the fact that practically the whole epidemic occurred in the small 
fraction unvaccinated is most convincing. In a number of these cases 
other members of the family were unprotected, but by prompt vacci- 
nation the spread of the disease was prevented. 

Our county seems to have been peculiarly free from epidemics dur- 
ing the past year. Dr. Shipps, of Bordentown, reports a number of 
' cases of typhoid fever, due, in his opinion, to pollution of the 
Delaware river, from which the city gets its water supply. A few 
mild cases of measles and scarlet fever have occurred, but no general 
epidemic. 

Dr. Marcy, of Riverton, reports the following case of scarlet fever 
with an interesting series of complications : 

Mary M., a strong, healthy child, was taken sick on January 2d, 
and developed a well marked case of scarlet fever. The type of the 



REPORTS OF DISTRICT SOCIETIES. 269 

disease seemed to be of a very mild character, and for a few days she 
seemed to do very well. On the sixth day she had a decided 
deposit of membrane on her faucial tonsils also extending into 
the post-nasal spaces. Cultures showed true Klebs-Loeffler bacilli, 
and she was injected with i,cx)o units antitoxic serum, which was 
repeated in twenty-four hours. A marked improvement immediately 
followed. She convalesced rapidly, and seemed to be nearly well, 
when an acute nephritis begun. This continued for a number of days, 
when it also began to improve. At this time she began to complain 
of severe headaches, pain in left arm, and frequently vomited. The 
pain in the head increased in severity until it was unbearable. A 
diagnosis of probable abscess of brain was made, and this diagnosis 
was confirmed by operation, when an abscess containing four ounces 
of pus was evacuated. The child died eight hours after this opera- 
tion. 

The interest in the meetings of our society has been well sustained, 
and the attendance good. We have lost during the year no members 

by death. 

Respectfully submitted, 

JOSEPH STOKES, Reporter. 



CAMDEN COUNTY. 

To the Chairman of the Standing Committee, &*c.: 

The regular October meeting of the Camden District Medical 
Society having been held at Blackwoodtown Hospital and Almshouse 
by invitation of the Camden County Board of Freeholders, the mem- 
bers, after a much enjoyed festive gathering, under the auspices of 
the Board of Freeholders, were escorted through the county buildings, 
and were very much impressed with the wisdom and completeness of 
their construction for the purpose designed. We were induced to feel 
considerable pride in our county buildings and their management. 
As regards some of the newer wards, we thought it would be hard to 
find their equal in other institutions. 

At the meeting held December loth, Dr. Godfrey read a paper on 
*' The Treatment of Tuberculosis in Sanataria," but we have not been 
able to obtain the manuscript. 

Dr. Godfrey also offered the following resolutions at this meeting, 
and they were adopted by the Society, viz.: 



270 MEDICAL SOCIETY OF NEW JERSEY. 

Whereas, Tuberculosis is a constant factor in the mortality of 
this State, causing each year more deaths than typhoid fever, scarlet 
fever, diphtheria, croup, measles, whooping-cough and smallpox com- 
bined, and amounting to about 1 1 per cent, of the death rate of the 
State; and 

Whereas, Tuberculosis is an infectious, contagious disease, com- 
municable through air, food and personal contact ; and 

Whereas. Science has demonstrated that the disease is prevent- 
able and, in a large percentage of cases curable ; and 

Whereas, The plan of segregating tuberculous subjects — the 
incipient cases in camps or sanataria, and the incurable cases in hos- 
pitals — has been tried abroad and in several States, and found to offer 
the best means for the cure and eradication of the malady and the 
protection of the public health ; therefore, be it 

Resolved, That this Society recommend to the Representatives of 
Camden county in the Legislature the enactment of a law providing 
for the establishment of a sanatarium. under Slate supervision, for the 
treatment of incipient cases of tuberculosis, which shall afford the 
best facilities for the personal care of the subject and the cure of the 
disease. 

Resolved. That the authorities of each county be specially auth- 
orized by enactment to establish hospitals for the care and treatment 
of incurable cases. 

Dr. Kelchner read a paper on "Tetanus, with the Report of a Case 
following Vaccination." He received the thanks of the society. 

At the February meeting Professor J. P. Crozer Griffith, of the 
University of Pennsylvania, read a paper on "Dietetic Maxims in 
Infant Feeding." He dwelt particularly on the importance of modi- 
fying the cow's milk to suit each case by a percentage method. A 
vote of thanks was extended to him for his practical and instructive 
paper. Several of the County Board of Freeholders being present by 
invitation, were interested in the subject of infant feeding, and some 
of them spoke on the subject, and referred to apparatus for the cool- 
ing of cow's milk and for manufacturing artificial ice. 

At our May meeting Dr. J. F. Leaviit, Physician in charge of 
Municipal Hospital, made the following report on the smallpox epi- 
demic and vaccination, viz : "Since October, 1901, we have had nearly 
two hundred cases of smallpox in this city (Camden). About one 
hundred and twenty-five of these have been treated at the Municipal 



REPORTS OF DISTRICT SOCIETIES. 27 1 

Hospital, and the others at their homes. From October 19th, 1901, 
to March 15th, 1902, we treated one hundred and two cases. Of 
this number eighty-six were smallpox, as follows: Confluent, fifty 
cases, with thirteen deaths; discrete, thirty-seven, with.no deaths. 
The remaining fifteen were varioloid, with no deaths. Only twenty- 
four cases out of the one hundred and two cases had ever been 
vaccinated. Of this number nine had been vaccinated within one 
week of coming to the hospital, and the majority of this nine were 
vaccinated after the first symptoms of smallpox had developed, and 
the vaccination ran a simultaneous course with the smallpox. Only 
one case seemed to be modified by the vaccination. Of the remaining 
fifteen vaccinated cases, not one had been vaccinated within ten years. 

Only two cases had real smallpox that had ever been vaccinated, 
and they were done twenty-five and thirty years ago. To counter- 
balance this we had one case of confluent smallpox in a colored man 
who had had confluent smallpox once before, thirty years ago. This 
statement was verified by pits and marks on his face and by a number 
of his friends who knew him and also the time he had it. 

As regards vaccination, my experience with the powers of vaccina- 
tion is, that it diminishes the liability of an attack of the disease, 
smallpox. It modifies the character of the disease, causing a much 
less fatal and less severe type, and that it absolutely protects from the 
disease if done recently, also that in a majority of cases the efficiency 
of vaccination never entirely ceases, and that revaccination restores 
that protection which that of time has diminished. The beneficial 
effects of vaccination are in proportion to the thoroughness of the 
vaccination. In summing up, vaccination, to my mind, is one of the 
greatest, if not the greatest, scientific discovery of the medical pro- 
fession. A gift of God to mankind, discovered and introduced into 
the great and noble profession of medicine by the lamented Jenner. 
Other things have been put out for sale, and were said to prevent 
smallpox. All of these have been tried and found wanting, having 
shown no effect whatever. Vaccination, with good virus, is the only 
thing known that will prevent smallpox, and that it will do every time.'* 

Your reporter would like to add a word in favor of vaccination, 
having been one of the twenty-four physicians to perform free vacci- 
nations within the City of Camden. After the vaccinating physicians 
had been vaccinating during January, the question arose whether our 
appointment should be continued for two weeks longer. This request 
was granted, but our success in getting new cases to vaccinate was 



272 MKDICAL SOCIETY OF NEW JLKSEY. 

extremely poor, owing to the desire of being vaccinated having ceased, 
because the report was going around that smallpox was " dying out." 
This it was actually doing, owing to the great numbers which we had 
vaccinated, added to those who concluded to be vaccinated by their 
private physicians. 

This fact practically left a small number for smallpox to feed upon- 
I had heard it said by Dr. Welch (I think), of the Philadelphia Muni- 
cipal Hospital, in the early part of the epidemic, that, '• If everybody 
would be recently vaccinated smallpox would die out in three weeks." 
Our experience of the January vaccination tended to prove the truth 
of his words. It only renewed the testimony each generation appears 
to need before it will consent to be vaccinated. How unfortunate it 
is that, while we have the evidence of the power of vaccination over 
smallpox fresh before us, our law makers will not try to make vacci- 
nation compulsory, as it is in that wise, far-seeing country, Germany. 

At a special meeting of the Camden District Medical Society, held 
December loth, 1901, the following resolution was passed, viz : 

Resolved, That the Camden District Medical Society recommends 
vaccination as tht preventative and protection against smallpox, and 
also that this resolution be published in the daily papers. 

At the May meeting, Dr. Braddock reported that in Haddonfield 
and the neighborhood they had eight cases of smallpox, with no 
deaths. As far as could be gathered there was no history of success- 
ful vaccination as respects these cases. There have been a few cases 
of scarlet fever, n^easles and whooping cough, but no epidemic. There 
were also a number of cases of influenza. 

Dr. Bennet reported that five cases of smallpox occurred in Glou- 
cester since last report, with no deaths. Three of these, which had 
been vaccmated, had smallpox in a modified form, while the one that 
had not been vaccinated had it in confluent form, and was a very 
severe case, lasting several weeks. One case unsuccessfully vacci- 
nated also had the disease in confluent form. He says that there is 
also an epidemic of measles now appearing. During January, Feb- 
ruary and March, several cases of mfluenza, also pneumonia and 
whooping-cough occurred. 

Dr. J. Anson Smith, of Blackwood, reporting concerning diseases 
most prevalent would say, the community has been particularly free 
from contagious diseases, but one case of smallpox being reported for 
the entire winter. The grippe has been much less prevalent than in 
former springs. 



REPORTS OF DISTRICT SOCIETIES. 273 

Dr. J. F. Leavitt reported that, during the year from July ist, 1901, 
to May 1st, 1902, diseases such as diphtheria, scarlet fever and typhoid 
fever have not been very prevalent in Camden. During this time we 
have only had in this city sixty-one cases of scarlet fever, one hundred 
and thirty-eight cases of diphtheria and twenty-seven cases of typhoid 
fever, and very few deaths from either of these. There has been 
about the usual amount of whooping-cough. At present measles and 
mumps seem to be quite plentiful. 

During the past year no deaths occurred among the members of the 
Camden District Medical Society. 

JOSEPH H. WILLS, Reporter, 



ESSEX COUNTY. 



To the Chairman of the Standing Committee : 

In accordance with the duty of the Reporter, permit me to offer my 
mite from Essex. The past year affords but little of interest, the 
usual conditions as regards health being about the average. No 
interesting case has been sent to me for record, so I presume none 
have occurred. Smallpox has been rampant, and still shows but few 
indications of its cessation, a pitiable commentary upon primitive 
medicine. 

During the early part of the year we had but a dilapidated building, 
which was a disgrace and a by-word, but, after ceaseless agitation by 
the Board of Health, of Newark, and the press, we now have proper 
buildings, a well trained corps of nurses, and every provision for the 
proper maintenance of those whose carelessness has made them a 
public charge. 

Death has kindly spared us this year, the only two being Dr. 
Bayles, whose obituary I enclose, and Dr. Thomas Dunn English, 
whose obituary will probably be presented at another time. 

I regret that I can offer nothing more, and again let me offer my 
apologies of the county for its apparent lack of interest in the support 
of its Reporter. 

Very truly, 

WILLIAM S. DISBROW. Reporter, 

18 



274 MEDICAL SOCItTY OF NEW JERSEY. 



i 



GLOUCESTER COUNTY. 

To the Chairman of the Standing Committee, etc. : 

The Gloucester County Medical Society has held five meetings 
during the past year. The November, January, March and May 
meetings were held at Woodbury, with an average attendance of 
twenty-four, together with delegates and visiting friends. 

Following the custom of the past few years, the September 
meeting being a purely social one. was held at Wenonah Inn, 
Wenonah, and like its predecessors was a pronounced success. 

The Reporter is pleased to record the fact that no deaths have 
occurred in our ranks during the past year. 

There has, however, been one resignation, that of George W. 
Bailey, who has removed to Philadelphia. 

Those elected to active membership were M. J. Luffbary, of Glass- 
boro, and Henry H. Clark, of Woodbury, making the total member- 
ship thirty-two. 

While the general health of the county has been good, we have had 
our usual visitation of influenza and pneumonia, together with the 
exanthemata. 

Perhaps, the most pronounced epidemic was that of scarlet fever, 
which has continued with us for several months. In some sections it 
has been impossible to quarantine, owing to the fact that the cases 
were of a mild type, and the parents thinking it was simply a 
*• scarlet rash or scarlatina," did not consider it necessary to call in 
the family physician. 

Many instructive and interesting papers have been read and dis- 
cussed both by our active members and those from the medical 
centers who have become eminent in their specialties, making it on 
the whole, one of the banner years of the Society. 

W. GRANT SIMMONS, Reporter. 

SWEDESBORO, N. J. 



HUDSON COUNTY. 

To the Chairvian of the Sta?tding Committee^ etc. : 

This has been a particularly interesting and prosperous year for the 
Hudson County District Medical Society. It is in a healthy and 
growing condition, new blood has been added in the shape of twenty- 



REPORTS OF DISTRICT SOCIETIES. 275 

one members during the year,*making a total of one hundred and 
thirty-seven members to date. There have been no deaths and no 
resignations. We have had four regular meetings, and the following 
essays have been read and discussed : 

*• Tuberculosis, medical and surgical," by L. G. Lambert, M.D. 

'* The relations of albuminuria to puerperal eclampsia," by Dr. E. 
Mills Baker. 

" A method to shorten the first stage of labor in primipera," by 
Dr. E. C. Armstrong. 

" The pathology of appendicitis " (illustrated by lantern slides), by 
Dr. George E. McLoughlan. 

We now stand second in the State in point of numbers, but second 
to no medical society in the State of New Jersey in point of interest- 
ing and instructive meetings. 

H. H. BURNETTE. M.D., Reporter. 

HOBOKEN, N. J., May 20th, 1902. 



HUNTERDON COUNTY. 

The two regular meetings of this Society were well attended and 
the proceedings of an interesting character. At the annual meeting 
Dt. Salmon, of Lambertville, exhibited a boy with progressive 
muscular atrophy, giving a clinical history of this interesting case 
with remarks of diagnosis, prognosis and treatment. 

Dr. G. L. Romine reported an unusual case of interstitial nephritis, 
running a rapid course, in which the leading symptoms were con- 
tinued nausea and extreme nervousness. A post-mortem confirmed 
the diagnosis. Dr. E. W. Closson reported an interesting case of 
extra-uterine pregnancy, occurring in his practice, in which the" diag- 
nostic symptoms were somewhat obscure. The patient was operated 
on by Dr. Mordecai Price and made a good recovery. 

The sanitary condition as well as the general health of the inhab- 
itants of this county during the past year have been fairly good. But 
comparatively few cases of la grippe appeared during the winter and 
spring, and these mild in character, and usually unattended with 
sequelae. ' Smallpox appeared in various parts of the county, but not 
in an epidemic form. Dr. O. H. Sproul reports two cases at Fleming- 
ton and five at Ringoes, with one death. There were two cases at 



276 MEDICAL SOCIETY OF NEW JERSEY. 

Raven Rock. Prompt action on the part of the boards of health 

prevented the disease from spreading from the places where it first 

appeared. A few cases of typhoid fever have appeared during the 

latter part of the spring, mostly in the Delaware Valley. 

It becomes our sad duty to report the following deaths : Dr. Henry 

Race, formerly an active member of this Society ; Dr. Mathias AbeU 

formerly an active, but more recently an honorary member, having 

moved from the State; Dr. Arthur J. Martin, an active member. 

Suitable obituaries of these worthy men arc in preparation. 

G. N. BEST. Reporter, 
May 1st, 1902. 

MERCER COUNTY. 

To the Chairman of the Standing Commit4€e^ etc. : 

The attendance at the meetings of the Mercer County Society has 
been very encouraging, and much interest in its welfare has been 
shown by the discussions arising over the many profitable papers 
which have from time to time been brought before the members for 
their mutual benefit and instruction. 

During the year five new names were enrolled upon the Society's 
membership, including one honorary member. 

The annual banquet meeting of the Society was held November 
1 2th, 1 901, with an unusually large attendance, forty of the members 
being present with their guests. Dr. Frederick A. Packard of the 
University of Pennsylvania, who was the guest of honor, gave a 
valuable and instructive address, having for his subject, *• A Consid- 
eration of a few of the Signs and Symptoms Designated by Proper 
Names." The address was greatly appreciated, as the speaker made 
his subject interesting and very useful. 

Dr. G. N. J. Sommer. at the December meeting, gave a very interest- 
ing talk upon ** Resection of the Sigmoid Flexure." The case at 
first, was one of suppurating ovarian cyst, the cyst being about the 
size of an orange. This was removed, and upon examining the 
sigmoid, 8 cm. of inflammatory stricture was found, seven inches of 
the sigmoid was removed, the ends united with a third size Murphy 
button, which passed successfully in thirty days, and the patient made 
a rapid recovery. 

The doctor also reported a case of ** Hysterectomy, Werdcr's 
Method." The patient married, thirty-four years of age, complained 



REPORTS OF DISTRICT SOCIETIES. 277 

of vaginal hemorrhage, no pain, offensive vaginal discharge between 
bleedings. Menstruation irregular before marriage, regular after, 
eleven children, three miscarriages. Examination disclosed rectocele 
bilateral tear of cervix, cauliflower growth, filling vagina, extending 
up cervix to vaginal junction, uterus movable, no induration in broad 
ligament, fundus large, ovaries and tubes normal. 

Operation. — Median incision, pelvis found to be normal, except one 
gland on left side, 4x1 ^^ c. m. ; this was removed, all vessels, tubes, 
etc., tied off and freed. The abdomen was then closed, and the uterus 
and tubes removed by vagina. Patient made a good recovery. 

Dr. F. V. Cantwell reported a case of extra-uterine pregnancy 
going to full term. 

Dr. E. S. Hawke gave a decidedly interesting " Report of Several 
Cases of Diphtheria," at the June meeting. All cases received anti- 
toxin in the first twenty-four hours. Five or six suspicious cases 
received antitoxin, not developing diphtheria, but contagious in char- 
acter, no ill effects resulting from its use, and recovery hastened. 
The speaker believes in early administration, no great degree of heart 
depression resulting, by hastening the elimination of the Klebs- 
LoefHer bacillus, we lessen the toxaemia, thus lessening the strain upon 
the heart. Twenty-three consecutive cases with twenty-three recov- 
eries, supports the great advantage of antitoxin administration. 
Seventeen cases were children between the ages of five and six, six 
were adults ; three of the cases were operated upon and two had 
"black diphtheria." 

Dr. B. W. McGalliard reported " The Results of the Use of Anti- 
toxin in Cases of Diphtheria Reported to the Health Board." 
Between June ist, 1896 and May ist, 1899, 44° cases were reported, 
318 received antitoxin, 36 died; mortality, 11.3^. In I22 cases anti- 
toxin not administered, 35 died ; mortality, 28.6^, this mortality being 
i\ times greater than the former. 

Of fifty-two families afflicted, 
5 cases occurred in 4 families. 

A << 4< (4 tm C( 

>> << II «( ■w/y << 

2 " " *' 29 " 

Dr. M. W. Reddan read a " Report of a Case of Typhoid Perfor- 
ation, with Operation, and Specimen." The writer gave a detailed 
account of the case. The operation was indicated on the sixteenth 



278 MEDICAL SOCIETY OF NEW JERSEY. 

day of illness, by the chills, temperature going to 95**, stabbing 
abdominal pain, pulse jumping from 84 to 116, respirations from 28 
to 48, marked tympany, liver dullness obliterated, and by the general 
symptoms attending the state of collapse. 

operation. — Median incision through which foul gas, fecal matter 
and lymph exuded, purse string, with two mattress sutures for addi- 
tional safety passed, abdomen closed without drainage ; immediate 
marked improvement was noticed and the patient's recovery looked 
for ; however, respirations dropped to 24 and from this time forward 
the patient began to sink and died at 3 A. M., six hours after 
operation. 

The writer thinks operation was justifiable and indicated, and 
would be repeated under like circumstances. 

Dr. James K. Young, of Philadelphia, presented before the January 
meeting, " A New Classification of the Disease of the Bones and 
Joints." His classification was well understood and, therefore, of 
great value in the diagnosis of many of the bones and joint compli- 
cations. Dr. Young was elected an honorary member of the Society 
at this meeting. 

Dr. Charles Allen, of the State Hospital, read before the Society a 
paper entitled, *' Some of the Less Frequent Nervous Accidents of 
Old Age." Many instructive points were brought out in dealing 
with the symptoms of these cases. 

Dr. Jno. Bruyere presented for discussion "A Report of Cases with 
Specimens." The speaker reported several very instructive and inter- 
esting cases, among the number being one of *' Carcinoma of the 
breast, following pancreatic cancer." 

Dr. George M. Ridgway read a paper entitled, *' Plea for an Early 
Operation in Appendicitis." The speaker presented five reasons in 
support of this plea, namely . 

I St. *' Ease of operation." 

2d. "Low mortality." 

3d. " Less liability of complications." 

4th. •' Small incision required." 

5th. " Good general condition of patient." 

The paper elicited much spirited discussion, and was thoroughly 
appreciated. He reported several cases of moderate symptoms, in 
which operation was performed early and in which delay would have 
proved fatal. 



REPORTS OF DISTRICT SOCIETIES. 279 

Dr. A. Dunbar Hutchinson presented " A Report of Twenty-tive 
Cases of Smallpox, Treated at the Municipal Hospital." The report 
shows that of the twenty-five cases, eight were successfully vaccinated 
in childhood, of these, five developed variloid, three smallpox, four 
were vaccinated within twelve months, two being successful, of the 
latter, one developed smallpox, the other varioloid ; two being unsuc- 
cessful, both developed smallpox. Thirteen were never vaccinated, 
eight of these developing severe confluent smallpox, and five mild 
varioloid. The pitting was most noticeable in the unvaccinated, but 
the depth of this was to a great degree avoided by the local treatment 
of hydrarg. unguent et petrolati. The report supports the urgent 
necessity of early vaccination. . 

Dr. Elmer Barwis, whose efforts were untiring in behalf of the bill 
providing for a State Tuberculosis Sanatorium, was through the 
efforts of the Society, placed upon the State tuberculosis sanatorium 
commission, the honor of which is appreciated by the society. 

The Trenton Medical Library Association is a new addition this 
year to our many progressive features. The officers are : President, 
Dr. H. G. Norton ; Vice-President, Dr. F. V. Cantwell ; Secretary, 
Dr. G. N. J. Sommer; Treasurer, Dr. Isaac Cooper. 

The Association is incorporated under the New Jersey State laws; 
and bids well to a rapid and substantial progress to a high position 
in the Medical Library line. Already there are about 500 interesting 
and valuable works in the possession of the Association. 

The health of the City during the past year has been excellent with 
the exception of a slight increase of typhoid and within the past six 
months the occurrence of a few cases of smallpox, however, no 
serious outbreak is feared. The Health Board is putting forth every 
effort to keep the ravages of smallpox from our homes and the 
result is most satisfactory. Free vaccination, isolation of patients 
and the quarantine of all suspects is the method pursued. 

The City health officers, report is gratifying. 

From May ist, 1901, to June ist, 1902, the following contagious 
diseases were reported : 

Diphtheria 33 

Typhoid 90 

Scarlet Fever 36 

Smallpox 35 

Tuberculosis 34 



28o MEDICAL SOCIETY OF NEW JERSEY. 

The hospitals in City have all far exceeded the records of the 
previous year, and are extending and increasing their facilities on 
every line. 

Reports from our out-of-town physicians are most favorable, they 
reporting no epidemic and no great degree of sickness. 

A. DUNBAR HUTCHINSON, Reporter, 



MIDDLESEX COUNTY. 

To the Standing Committee : 

It gives me pleasure to report a. greatly increased activity in 
our society. During the last year seven new members have 
been added to our number. Our quarterly meetings have been well 
attended and were marked by papers which brought out much discus- 
sion, and a social session which added greatly to the enjoyment of 
the occasion. For our annual meeting in April, we secured the 
services of Dr. Jay F. Schamberg, of Philadelphia, who gave us an 
instructive talk on smallpox, profusely illustrated with lantern slides. 
It was an opportune paper, as at that time in New Brunswick,we were 
having a few cases of the dread disease. There were in all only 
twelve cases, all of which were traceable to workmen brought in by 
the Delaware & Raritan Canal Co., and the Trenton & New Bruns- 
wick Trolley Co. Several of the cases were quite severe with two 
deaths occurring at about the end of the first week. 

There was quite an outbreak of the disease in December and Janu- 
ary last at Sayreville, traceable to a boatman who had been plying 
about New York Harbor. This man, who had never been vaccinated, 
came home suffering with an extremely mild attack of smallpox, which 
on that account was not promptly recognized, having been considered, 
as has frequently happened, to be chickenpox, until the victims of the 
first exposure fell ill. In the meantime a large number of people had 
been exposed. Vaccination was promptly and rigidly enforced, and 
the actual number of cases was limited to about thirtv-five, with two 
deaths. 

I have also to report the great loss which our District Medical 
Society has sustained in the death, on February 4th, 1902, of Dr. 
Henry R. Baldwin. As an expression of our esteem, the following 
resolutions were adopted by the Society, Viz : 



REPORTS OF DISTRICT SOCIETIES. 28 1 

(These resolutions will be found in Dr. English's sketch of Dr. 
Baldwin, among the obituaries published in this volume of *' Transac- 
tions.") 

A. L. SMITH, M.D., Reporter. 



SOMERSET COUNTY. 

To the Chairman of the Standing Committee^ etc.: 

Somerset County has to report the year past as one characterized 
by the usual average attendance and by the usual quantity and quality 
of interesting professional discussion at its meetings. Early in the 
year — July i, 1901 — Dr. H. G. Wagoner, one of the oldest members, 
and known almost, if not quite, as widely throughout the profession of 
the State as of the county, was overcome by a heat stroke, surviving- 
the stroke barely a half day. His loss is greatly felt, and those who 
in the past have been associated with him professionally and socially, 
in the county and in the State, will long hold dear in memory the 
recollection of the matured physician, who combined with his store of 
medical experience drawn from nature's own text book, through years 
of active service, the genial affability of the cultured gentleman. His 
obituary appears elsewhere. At the regular meeting of July, Dr. 
Anderson opened a discussion upon the subject of headache. At the 
regular meeting in October, Dr. M. C. Smalley read a paper upon 
Haemorrhoids. At this meeting, also, a By-Law was adopted to the 
effect that all dues to the State Society must be paid thirty days 
before the State meeting. At the January meeting. Dr. W. H. Long 
read a paper upon tuberculosis of the spine and its treatment. At the 
annual meeting in April, the election of officers for the ensuing year 
resulted as follows : President. Dr. S. O. B. Taylor, of Millstone ; 
Vice-President, Dr. C. R. P. Fisher, of Bound Brook ; Secretary, Dr. 
A. L. Stillwell, of Somerville ; Treasurer, Dr. J. P. Hecht, of Somer- 
ville; Reporter, Dr. J. H. Buchanan, of North Plainfield ; Delegates 
to the State Medical Society, Drs. Mary Gaston, T. H. Flynn and W. 
H. Long, of Somerville, H. M. Weeks, of Skillman, and H. V. Davis, 
of North Branch. Following the transaction of the routine business. 
Dr. Chas. J. Kipp, of Newark, read a paper upon "The Modern Treat- 
ment of Traumatic Injuries of the Eye. " The subject was well and 



282 MEDICAL SOCIETY OF NEW JERSEY. 

simply treated and well suited to be of material help to the general 
practitioner. The promise of its early publication was hailed with 
delight. Following the paper, adjournment to the dining hall was in 
order, and a practical demonstration of applied dietetics was enjoyed 
by all. Dr. Ward, of the Trenton Asylum was present as an honored 
guest and an honorary member, and contributed in no small degree to 
the flow of good fellowship in evidence. Dr. H. M. Weeks, the head 
of the Epileptic Village at Skillman, was also kind enough to speak 
of the institution, its size, character, prospects, etc., ending with a cor- 
dial invitation to visit the institution and observe its operation — an 
invitation not restricted, I may say, to Somerset County alone. It has 
been the custom for some time in our Society, following the routine 
business, papers, etc., to indulge in an " informally formal " discussion 
of such interesting cases or phases of our art as may have come 
within our practice in the preceding months. These *' experience 
meetings," as Dr. Fisher terms them, are interesting in the extreme, 
and many points of practical usefulness are elucidated. Here too, are 
reported many of those constantly occurring strange cases which every 
active physician meets, and which seem to strengthen the old adage 
that •* Truth is stranger than fiction." Dr. C. R. P. Fisher holds the 
palm this year, and is facile princeps as regards unique cases. I refer 
to the case reported elsewhere of the little girl who fell and was 
impaled upon a sharp stake. The professional modesty of Dr. Fisher 
forbids his extended discussion of the careful and conscientiously 
skillful attention that was responsible for the favorable outcome. Our 
society during the year has lost one member by death. Dr. H. G. 
Wagoner. It has gained three new members. Dr. Josiah Weigh, of 
Bernardsville, Dr. H. M. Weeks, of Skillman, and Dr. Arthur H. 
Dundon, of North Plainfield. The hospital established last year at 
Somerville is well under way, and has had a year of successful work. 
At no time has it been entirely empty, and a number of interesting 
cases have been sent there, and among them, a case of traumatic 
spreading gangrene, terminating in a septic pneumonia. There is at 
present a case of spinal fracture in the wards. A number of major 
and minor operations have been performed, the staff alternating their 
services in monthly terms. There is no dispensary, and the running 
expenses of the institution are all provided for. Miss Lorena R. Brokaw, 
a graduate of the Pennsylvania Hospital, Philadelphia, is in charge, 
aided by one assistant. The outlook is very bright for its growth and 



REPORTS OF DISTRICT SOCIETIES. 283 

extended usefulness. Of the prevalence of disease in the county, there 
is little to say, I think in common with the rest of the Stat€, that the 
amount of acute sickness has been considerably below the average. 
Grippe has been very infrequent since January, and what cases are 
noted have been mostly mild and without dangerous sequelae. Some 
cases of measles, chickenpox, and a few moderate cases of diphtheria 
have been noted, I have seen no case of smallpox reported from the 
county, though its near approach has been the cause of a pretty 
thorough vaccination, in the larger towns especially. 

J. HERVEY BUCHANAN, U,T>., Reporter. 
North Plainfield, N. J., May 17, 1902. 



AN UNUSUAL ACCIDENT CASE. 

BY C. R. P. FISHER, M.D., BOUND BROOK. 

About one A.M., October i6th, 1901, I was hurriedly summoned by 
telephone to see an eleven year old girl. Miss I. L., who, I was 
informed, had " fallen out of the window and run a stick into her 
side." Upon reaching the house I found the little patient lying on 
the bed, on her right side, perfectly conscious, but very weak. 
Removing the sheet with which she was covered, I saw a large mass 
of small intestine which had escaped through a rent in the abdom- 
inal wall which was afterward found to be about two and one-half 
inches in length, and situated about one inch below and one and 
one-half inches to the left of the umbilicus. There had been only 
trifling hemorrhage. These intestines were immediately wrapped in 
sterile gau2fe, and held in the hands of assistants for warmth and 
support, until she was placed on the operating table. Further exam- 
ination disclosed a wound in the back of the chest, between the ninth 
and tenth ribs, beginning at the posterior axillary line on the left side. 
and extending toward the spine, nearly three inches in length. 
Through this opening the air was rushing in and out with each inspir- 
ation and expiration ; the edges of this wound were drawn together 
and held temporarily by a strip of adhesive plaster. 

A messenger was at once sent to telephone Dr. F. M. Donohue, of 
New Brunswick, who very kindly responded with great promptness, 
and who remained associated with me throughout the entire treat- 
ment of the case. While awaiting his arrival I gathered the following 



284 MEDICAL SOCIETY OF NEW JERSEY. 

facts regarding the injury : The child slept in a second story room, 
and directly beneath her windows was a rosetrellis, consisting of two 
roughly dressed, unpainted cedar stakes, about seven feet high and 
one and three-fourth inches in diameter, with lath nailed to them at 
intervals. These stakes were as sharp at the top as a butcher's 
gambrel. While walking in her sleep the little girl had raised her 
window and fallen out, and had been impaled upon one of the cedar 
stakes, the stake entering the abdomen and emerging from the chest, 
through which it projected about five and one-half inches. She was 
obliged to remain hanging upon the stake until help could be pro- 
cured from a neighboring house, about one-half hour. When she 
was lifted from the stake the intestines were dragged from the 
abdomen, thus accounting for her condition when first seen by me. 

Ether was administered by Dr. F. A. Wild, and with strictest 
aseptic precautions Dr. Donohue proceeded to operate, assisted by 
myself; we found in all, four perforations of the intestine and two of 
the omentum. Two small transverse slits in the bowel, about one- 
third of the circumference, and one larger one, about two-thirds, were 
united by catgut sutures ; in the remaining bowel wound nothing but 
the mesenteric insertion was left for the space of over three inches, 
and here the divided ends were trimmed evenly and united by means 
of the Murphy button. The rents in the omentum were sutured in 
such a way as to occlude all the blood vessels which might ooze, and 
the mass of intestine and omentum was then washed thoroughly 
with hot sterile salt solution and returned to the abdominal cavity. 
The wound was then packed with iodoform gauze, and the usual 
laparotomy dressings applied. The chest wound was also packed with 
gauze and similarly dressed. It was feared at one time that the 
patient would die on the table, and when she was placed in bed the 
pulse was uncountable, and the respirations about 64. At the end of 
twelve hours the temperature was 104.1, and respirations still 64. 
She was nourished entirely per rectum for the first few days, and 
partially so until the Murphy button was recovered, which was on the 
fifteenth day ; there was at no time any peritonitis or other serious 
trouble with the abdominal wound, and *it was entirely healed by 
December 1 2th, leaving a small ventral hernia. The wound in the 
diaphragm never caused any trouble, and apparently healed very 
kindly. 

The chest wound did well until November 6th, when a pneumonia 



REPORTS OF DISTRICT SOCIETIES. 285 

of the lower lobe of the left lung developed, evidently due to the 
traumatism, and which remained with varying intensity for a long 
time (exact time not noted). The discharge, which was at first 
serous, gradually became purulent ; during January and February 
several small pieces of cedar bark were found in the discharge, and 
one.small chip of bone (evidently from one of the ribs), and the 
amount gradually lessened until the wound closed completely about 
May 1st, 1902. The child seems to be entirely well, and is rapidly 
regaining her strength ; the left chest is considerably collapsed, but 
some expansion has already taken place, and the age of the patient 
gives hope of more. 

There were two circumstances connected with the accident which 
I think made recovery possible : First, the torn intestines hugged 
the stake so closely as to prevent leakage of their contents into the 
abdominal cavity, and when the stake was removed the intestines 
came with it, so that whatever leakage occurred was outside ; and 
second, the foreign matter left behind when the stake was removed, 
was left in the chest instead of in the abdomen. It is also remark- 
able that the stake could have penetrated the body for such a 
distance, in that locality, without wounding any large blood vessels 
or other important organs. 



WARREN COUNTY. 

To the Chairman of the Standing Committee^ etc: 

Warren County has suffered from but one epidemic during the past 
year, viz : that of smallpox at Hackettstown, and which is fully des- 
cribed in an excellent paper appended to this report, by Dr. Louis C. 
Osmun, of that town. You will note that While there were 125 cases 
of smallpox reported, there were only four (4) deaths, a death rate of 
about 3J per cent., which was certainly one of the most remarkable 
epidemics, in this respect, in the history of medicine and disease. 

The epidemic began the frst day of January, 1902, and the quaran- 
tine was raised the Jirst week of last April. There was a very effi- 
cient male nurse as chief in charge, and it is now reported that the 
said nurse has also suffered an attack of smallpox since his departure 
from Hackettstown, and passed successfully through the same— very 
unique, indeed. 



286 MEDICAL SOCIETY OF NEW JERSEY. 

There were a few cases of the disease outside the limits of Hack- 
ettstown, with one or two deaths, and at the present time there is one 
case in Phillipsburg, but will oo doubt be confined to its present loca- 
tion, as the Board of Health of the town has placed strict quarantine 
on the premises. 

We have had a few scattered cases of diphtheria, scarlet fever and 
measles throughout the county, with. a low death rate. 

Our District Society met at Belvidere in annual session, June 3d, 

1902, with a moderate attendance, at which some able papers were 

read and discussed. 

J. H. GRIFFITH, M.D., Reporter, 

Phillipsburg, N. J., June 13. 1902. 



THE EPIDEMIC OF SMALLPOX IN HACKETTSTOWN, N. J. 

BV LOUIS C. OSMUN, M.D. 

Our first cases began about January i, 1902, and were diagnosed 
smallpox, on January 4, 1902, and every case of this first inoculation 
can be traced to one source of infection, and that to a young man here 
in town who made a visit to the city early in December, and in about 
two weeks after his return he developed a slight, papular eruption on 
his face and body, which resembled chickenpox very much, and was 
diagnosed as such, and he was advised to go home and stay there ; 
but suffering no inconvenience, he did not do as he was told, but con- 
tinued to roam about wherever he wished ; and on December 19 and 
20, 1 90 1, he visited a show which was held in the town opera house 
and was general master of ceremonies for the occasion, and the result 
was that nearly every unvaccinated person that visited the same show 
was inoculated with smallpox. In just 14 days from this entertain- 
ment Hackettsto^yn had about 55 well-developed cases of smallpox on 
its hands as the result of one infection. Some lively work was done 
by our local Board of Health and physicians as well. Wholesale vac- 
cination was begun and continued until every man, woman and child 
that could be prevailed upon, was vaccinated. The new town hall 
was converted into a hospital for the male patients, and they were 
removed there as fast as possible, and soon after another building was 
erected as an isolation hospital for females, to which they were removed 
as fast as possible. 

Here they all received good care in the hands of trained nurses, and 



REPORTS OF DISTRICT SOCIETIES. 28/ 

all did well. There were 93 cases treated in the two hospitals, with 
three deaths. Two of these deaths were of very old people, one of 
which died from gangrene and the other from paralysis. ' Both these 
cases were so far advanced with- the smallpox as to be convalescing 
when the other disease appeared which caused death. Three distinct 
types were clearly shown in this epidemic, viz : Confluent, discrete 
and varioloid, of these there were 28 confluent, 49 discrete and 42 
varioloid. Only 12 of .these were ever vaccinated and these had vario- 
loid. The remaining 30 varioloids were cases that were vaccinated 
successfully at the beginning of our epidemic and after they had been 
exposed to infection. These had very sore arms which unquestionably 
modified the disease and made it varioloid. Out of the 12 that had 
been vaccinated previous to the epidemic, only three had been vacci- 
nated recently. Two were vaccinated 2 years ago but were not very 
successful. One was vaccinated 4 years ago, and had quite a sore 
arm ; two were vaccitated 40 years ago, one 58 years ago, four 
30 years ago, and two 20 years ago. 

In most of the light cases there was very little permanent pitting, 
but in the more severe cases the pitting was considerable. This seems 
to be governed largely by the extent of the ulceration in the skin which 
varies in different patients. Those with light complexion and fair 
skin were pitted but very little, while those with a dark skin have more 
permanent marks. The odor of smallpox is very characteristic. It is 
exceedingly repulsive and cannot be compared to that of any other 
disease. Large crops of boils were also seen in most of the patients, 
coming just after the first crusts had fallen off and many of then) 
were very large and had to be opened. Out of this lot of cases we 
had one case of pregnancy at the sixth month. This woman had never 
been vaccinated and had confluent smallpox and was very sick, but 
she carried her child to full term and gave birth to a perfect boy baby 
without a single mark on his skin that would indicate smallpox. This 
woman made good recovery but was the most tedious one we had. 
Her skin did not clear up as readily as the others and it was 13 weeks 
before her skin stopped desquamating so that she could be discharged 
from the hospital. 

Each case is one by itself, and no fixed rule can be laid down as 
to when a patient can be discharged from the hospital. Our shortest 
case was discharged in 5 weeks, and the longest was 13 weeks, but the 
most of them were ready to leave in 8 weeks. No patient should be 



288 MEDICAL SOCIETY OF NEW JERSEY. 

discharged until all scaling has ceased and the bright redness has dis- 
appeared from the base of the marks, for so long as there is a bright 
red color and a gloss in the pits, desquamation is going on and they 
are contagious. 

In conclusion I wish to give the history of one very interesting case : 
A young man aged 24 years, giving a family history of tuberculosis, 
and an inveterate cigarette smoker, was coughing and expectorating 
freely and had been doing so for six months, had night sweats, was 
very emaciated, no appetite and a temperature of 103^, and had been 
down in bed for 3 weeks and had every appearance of filling an early 
grave. He had never been vaccinated, and refused on account of his 
weakness, and on February 11. 1902, after complaining very hard for 
three days, he broke out with smallpox. In less than twenty-four 
hours from the time the eruption appeared his cough ceased, his 
temperature came down to normal and every symptom pointing to a 
disease of his lungs ceased and he has not coughed since. He had 
confluent smallpox, a good crop of it, made a good recovery, and he is 
now fat and looking fine and says he never felt so good in his life. 

I do not wish to advocate smallpox as a cure for consumption in 
all cases, but this young man is a good example of incipent tubercu- 
losis which was apparently arrested by the sudden onset of another 
still more contagious disease, and now the man is well. There is 
a something in the blood which a contagious disease changes and 
renders us immune to another attack of that same disease, and 
whether that change in the blood which smallpox produces has any 
effect in destroying the activity of the tubercle bacillus, I am not pre- 
pared to say, but this case looks very much as if it did in the early 
stages of tuberculosis. 

P. S. — There were thirty-.two (32) cases treated in the town, aside 
from those in the hospitals, with one death. — O. 



CONTENTS. 



-♦♦♦► 

PAGE. 

FELLOWS PRIZE ESSAY 

OFFICERS 4 

FELLOWS....: 5 

HONORARY MEMBERS 7 

PERMANENT DELEGATES 8 

MEMBERS OF DISTRICT SOCIETIES 11 

SUMMARY OF MEMBERS 33 

MINUTES 35 

APPENDIX TO THE MINUTES— 

Report of Treasurer 75 

Report of Corresponding Secretary 76 

Report of Recording Secretary 77 

Report of Committee on Business 79 

Report OF the Committee op Arrangemrnts 81 

Report of Committee on Honorary Membership 82 

Report of Delegates to the American Medical Asso- 
ciation 84 

Report of Delegate to the Conference of the Commit- 
tee on National Legislation '. 85 

Report of Committee on Sanatorium 86 

Report of Dr. Kipp, President of the Board of Managers 

OF the Sanatorium 88 

Report of Committee, on Bovine Tuberculosis 89 

Report OF Committee ON Abuse of Medical Charity 90 

Report of Committee on Milk as a Food and as a Means 

OF Contagion 91 

Correspondence Relating to an Old Parchment Con- 
taining A Petition to the Legislature for a Charter 

FOR THE Medical Society of New Jersey 99 

Nurses' Organization .' 102 

Address of the President, by John D. McGill. M.D 103 

The Pathology of Appendicitis, by Geo. E. McLoughlin, M.D. 115 
The Rural Surgeon, His Place, Privilege and Duty, by 

A. W.Taylor, M.D 121 

The Present Methods of Education, from the Stand- 
point OF THE Physician, by Joseph Tom linson, M.D 131 

Report of Committee on Legislation 143 

Valvotomy, as a Surgical Measure for the Cure of 

Obstinate Constipation, by Wm. M. Beach, A.M., M.D.. 145 



2gO CONTENTS. 

PAGE. 

Further Report on the Use of Ethyl-Bromid as a Pri- 
mary Anesthesia to Ether, by Emery Marvel, M.D 151 

The Cause op Sore Arms in Vaccination, by Alexander 

McAllister, M.D 153 

The X'RAYS as a Cure for Cancer, by Dowling Benjamin, M.D. 158 

Radical Operation for the Relief of Chronic Purulent 
Diseases op the Middle Ear, by F. C. Ard, M.D 161 

Report prom the Fellows 165 

The Causes and Treatment of Sterility in Women, by 

Edward J. 111. M.D ,,... 166 

Tetanus Complicating Vaccination, by Alexander McAllister. 

M.D 185 

A Plea for the Early Diagnosis and Treatment of Can- 
cer OP the Womb, by G. H. Balleray, M.D 190 

Brain Abscess of Otitic Origin, by Wells P. Eagleton, M.D.. 194 

Supplementary Notes on Abortion of Mastoiditis, by 

Talbot R. Chambers, M.D aoi 

Exhibition of New Obstetrical Forceps, by Dowling Ben- 
jamin, M.D 208 

The Surgical Elevation of the Stomach for the Cure 

Gastroptosis, by Henry D. Beyea, M.D 309 

Report of a Case of Intestinal Obstruction, by E. A. Y. 

Schellenger, M.D 318 

Report of a Case of Tumor of the Orbit, by George Evans 

Reading, M.D 230 

The Power of Vaccination in Preventing Smallpox, by 

J. F. Leavitt, M.D 322 

Report of the Standing Committee 336 

Progress in State Medicine and Hygiene, by Edward E. 

Worl, M.D • • • • 330 

Progress of Diseases of the Nose, by B. A. Waddington, M.D. 335 

Report of Progress in Ophthalmology and Otology, by 

Talbot R. Chambers, M D 338 

I.N MEMORIAM 346 

obituaries- 
Alexander Mecray, M.D 349 

W. H. Smith, M.D 350 

George Bayles, M.D : 251 

Thomas Dunn English. M.D 253 

Henry Race, A.M., M.D 254 

Henry Rutgers Baldwin, M.D., LL.D 255 

Henry G. Wagoner, M.D ..; ;... 260 

George Matthias Swaim, M.D..: 261 

Mathias Abell, M.D , 262 



CONTENTS. 291 

PAGE. 

REPORTS OF DISTRICT SOCIETIES- 
ATLANTIC COUNTY, Report by A; B. Shimer, M.D 265 

BERGEN COUNTY, Report by J. W. Proctor, M.D a66 

BURLINGTON COUNTY, Report by Joseph Stokes, M.D 267 

CAMDEN COUNTY. Report by Joseph H. Wills, M.D 269 

ESSEX COUNTY, Report by William S. Disbrow, M.D 273 

GLOUCESTER COUNTY, Report by W. Grant Simmons, M.D.. 274 

HUDSON COUNTY, Report by H. H. Burnette, M.D 274 

HUNTERDON COUNTY, Report by G. N. Best, M.D 275 

MERCER COUNTY, Report by A. Dunbar Hutchinson, M.D 276 

MIDDLESEX COUNTY, Report by A. L. Smith, M.D 280 

SOMERSET COUNTY, Report by J. Hervey Buchanan. M.D... . 281 

WARREN COUNTY, Report by J. H. Griffith, M.D 285 



The Medical Society of New Jersey does not hold 
itself responsible for the sentiments expressed by the 
authors of papers; nor for the reports of clinical cases 
furnished by the reporters of the District Societies. — 
Transactions. i8j6, page jS. 



1